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CORNELL 

UNIVERSITY 

LIBRARY 




THE WASON 

CHINESE 
COLLECTION 



Cornell University Library 
RA 901.D84 



The diseases of China :their causes, con 




3 1924 023 608 445 




Cornell University 
Library 



The original of this book is in 
the Cornell University Library. 

There are no known copyright restrictions in 
the United States on the use of the text. 



http://www.archive.org/details/cu31924023608445 







THE 



DISEASES of CHINA; 



THEIR ' 

CAUSES, CONDITIONS, AND PREVALENCE CONTRASTED 
WITH THOSE OF EUROPE. 



BY 



JOHN DUDGEON, M.D., 



PEKIN. 



GLASGOW: 

DUNN & WRIGHT 176 BUCHANAN STREET, 
And ioi STIRLING ROAD. 




l8 7 7- 



!& -_ ^. 




THE 



DISEASES OF CHINA; 



THEIR 



CAUSES, CONDITIONS, AND PREVALENCE, CONTRASTED 
WITH THOSE OP EUROPE. 



BT 

JOHN DUDGEON, M.D., 

PMKIN. 



GLASGOW: 

DUNN & WRIGHT, 176 BUCHANAN STREET, 

AND 102 STIRLING KOAD, 

1877. 



Bead before the MEDICO-OHIRUKGICAL SOCIETY OP GLASGOW, February 2\'d, 
1877, and Reprinted FROM "THE GLASGOW MEDICAL JOUBNAL" OP April 
a.nd July, 1877. 



THE DISEASES OF CHINA; 



THEIK CAUSES, CONDITIONS, AND PREVALENCE, CONTBASTED 
WITH THOSE OF EUROPE. 



BY JOHN DUDGEON, M.D. PEKIN. 



The subject of the present paper is a large and important one, 
and the time at my disposal will only admit of a very cursory 
glance at so large a theme. My object is to point out some 
of the more obvious of the differences in the diseases of the 
east and the west, and if possible to indicate the causes that 
are operating to produce these changes. On account of the 
great antiquity of the Chinese nation, the vitality of the 
Chinese, the great population, territory and range of climate, 
the field in a medical point of view is specially interesting. 
What, however, is predicated as true of China will hold true, 
to a greater or less extent of all Asia, and so in like manner, 
we might safely argue from any one European country to all 
the rest. The question of disease becomes, therefore, of 
importance in relation to race, so similar and yet so different 
are the Oriental and Occidental types of disease. The 
Asiatic customs and social peculiarities, in my opinion, con- 
duce to a higher vitality and a greater freedom from acute 
and inflammatory affections. On that continent life is more 
quiet and easy ; the Asiatic drinks less stimulating pota- 
tions, eats simpler food, keeps better hours, marries earlier, 
takes more care of himself ; his passions are more subdued, 
and his whole life and its actions more under the control of 
reason and religion. Race thus modifies disease, and vice 



versa. The climate and physical features of a country, and 
the food and the diseases which depend thereupon and which 
destroy or impair vitality, are the principal influences direct- 
ing the development of the permanent characters of a race, 
and the chief agents consequently by which race is propa- 
gated and type constituted. Physiological peculiarities are 
more acquired than primitively impressed. The acquired 
and transmitted qualities, with the existing social customs, 
are amply sufficient factors for the production of every variety 
or degree of vitality which may distinguish any race. These 
peculiarities affecting stature, health, and duration of life 
are more dependent upon the combined influences of food 
and customs, acting through many ages, than mere climate 
alone. Simple hygienic precautions which we find efficacious 
in one country are useful in others, and with proper atten- 
tion to such rules the deadly effects of climate disappear. 
The cultivation of temperance in all things, general sober- 
ness of life, and all else that would prove useful to us in 
Europe in enabling us to remain vigorous to resist malign 
influences, is of equal value to us in the East. We are in 
the habit of speaking of a certain invariableness in the type 
of disease — like causes producing like effects— that disease 
retains this type in all forms of civilisation, in all climes and 
all ages. Very few diseases have appeared, very few have 
disappeared. Some have become graver in certain localities, 
countries, and civilisations than others, but sporadic cases of 
any disease assume the same type as the same disease in its 
epidemic or endemic form. Although this is undoubtedly 
-true, it is nevertheless also true that many diseases which 
were either rare or almost unknown have sprung into no- 
toriety and have assumed severer forms, and have added 
greatly to our mortality bills. Although this invariableness 
of the type of disease still exists in certain nations and indi- 
viduals, we are accustomed to speak of the rise of such dis- 
eases as small-pox, diphtheria, cholera, and syphilis ; of the 
extension of certain diseases to regions where they were 
before unknown, as, for example, rubeola into the South Sea 
Islands ; and of the entire' disappearance or great diminution 



of diseases once prevalent, as e.g., ague, leprosy, and small- 
pox in our own country, by means of drainage, better cultiva- 
tion of the soil, improved modes of living, discovery of vac- 
cination, &c. And so we find disease bounded by both time 
and space, developed in some parts of the earth, undeveloped 
in others ; some developed in all parts, some confined ex- 
clusively to certain regions and completely absent from 
others, and all modified by the peculiarities already adverted 
to. Notwithstanding, however, this amelioration in the 
symptoms and total abolition of certain diseases, caused by 
our improved civilisation, this same civilisation, as exhibited 
in our present modes of life and surroundings — the true 
causes and explanation of the so-called change of type of 
■which we so often hear — have produced a large train of 
diseases that either did not exist, or existed only to a very 
limited extent a century ago, such, e.g., as the various nervous, 
cardiac, and, generally speaking, acute diseases. It cannot 
be altogether true, as is sometimes asserted, that these dis- 
eases may have existed, but were unknown owing to the 
imperfect state of medical knowledge and our means of 
diagnosis at that time. There would seem to be a law of 
the increase and diminution or total disappearance of certain 
affections in proportion to the state of civilisation. If this 
be so, I fear our present review will not prove favourable to 
our highly civilized and artificial life and its luxuries. The 
great strides made by European nations, and ourselves in 
particular, in trade and international intercourse with the 
ends of the earth, by virtue of our discoveries and inventions, 
whatever else may have been done in adding to the sum of 
human happiness and comfort, have not tended, either among 
ourselves or nations^ lower in the scale of civilisation, to 
longevity or the diminution of disease, but rather the 
reverse. The immediate effect is naturally that of propa- 
gating zymotic and other diseases, and that frequently, too, 
of a more virulent type than may previously have existed, 
into countries to which the spirit of commerce, colonisation, 
and civilisation may have led us. The ultimate effect will 
doubtless be to become better acquainted with the etiology 



of disease, and so by applying the means of cure or preven- 
tion, to stamp out, modify, and limit many of our present 
well-known diseases. To enable the reader to understand 
and contrast tbe conditions of disease in China with those of 
Europe, it will be necessary to describe as briefly as possible 
the various matters recognised as influencing or causing 
disease, such as the sanitary state of the country, the food, 
drink, habits, and social customs of the people ; for it is here, 
I think, where the chief differences will be found to exist, and 
so by contrast and inference to point out some of the causes 
of prevalent diseases in the West, and the errors of modern 
European life. It is in this department of the controllable 
diseases that our profession ought to take, and I am happy 
to say is taking, the initiative, as the prime ministers of the 
health of the nation. It is ours to lay down the law to our 
patients, the community, and the state ; to teach what our 
medical science and experience have made plain to us, and 
to show how the various phenomena of disease from these 
social causes may be modified or altogether avoided. We 
have, unfortunately, no powers to compel their acceptance 
but we can appeal to reason, common sense, and self-interest, 
and I believe we could do more in this direction than we are 
at present doing. I dismiss the argument that such a course 
-would be opposed to our self-interest as not entitled to a 
moment's consideration, and as quite opposed to the ideal 
of our profession. 

Climate. — From the great extent of China proper, or the 
eighteen Provinces, stretching from about 20° to 42° of lati- 
tude, and 97° to 122° of East longitude, and with a surface of 
over 500,000 square miles (not to speak of the still greater 
Chinese Empire, stretching through 77" of longitude, and 
40? of latitude), we have every degree of climate and tem- 
perature, from the cold of Sweden to the heat of Italy. The 
country resembles, in the North at least, the climate of the 
American Atlantic States. In such a vast extent of territory 
we may expect to find all the diseases to which we are accus- 
tomed in Europe, and although my own experience is almost 
solely derived from Pekin and North China, still I shall make 



free use of the results and observations of others in Central 
and Southern China, such as we find in these increasingly 
valuable Customs' half-yearly medical reports, and those of 
the various mission hospitals. The country is traversed 
from East to West by two mighty rivers, both of which 
occasion frequent and destructive inundations. The Chinese 
have greatly improved the advantages furnished them by 
their rivers for irrigation and navigation by digging canals. 
The Himalaya mountains may be said to divide Asia into 
North ,and South portions totally different from each other. 
China and North-Eastern Asia generally resemble more the 
northern part ? and from its elevated position, bordering on 
snowy mountains, and the regions of intense cold, China 
has a pretty rigorous climate, especially in the northern 
half. The monsoons of the tropics are felt but slightly, 
except in the extreme South. On the whole the climate 
may be said to be salubrious, invigorating, and favourable 
to longevity, without the great rigour of more northern 
regions and the enervating influences of the more southern. 
The average temperature of the whole empire is lower than 
that of any other country in the same latitude. More than the 
half is mountainous, chiefly in tbe South and West — the great 
plains are in the East and N.E. Cultivation is carried to a 
great extent everywhere — there is no meadow or pasture 
land. It is the most fertile of all the countries of Asia, 
though it owes much of its productiveness to its inhabitants. 
So' much for a few general preliminary remarks on the 
geography and climate of the country as a whole. Other 
points of more interest medically will be referred to in the 
course of the paper. 

Sanitary Condition, Sewage, Drainage, and Typhoid Fever. — 
China may be said, in a word, to be totally destitute of 
sanitary science. Take the following as a specimen of the 
condition of sanitation at Canton. Dr Wang is speaking of 
typhoid fever, and he says he saw only two cases during a 
period of more than 10 years. He has seen many cases of 
remittent and intermittent fevers, but never one of typhoid. 
It may therefore be safely affirmed that this disease is not 



at all prevalent, although we should expect a different state 
of things, as the causes that are usually supposed to produce 
typhoid fever are in full operation. In Canton large num- 
bers of the natives are daily using water and inhaling air 
charged with the impurities of human excreta, apparently 
with utter impunity. River water is greatly used, and that 
used by the boat population along the different jetties is 
extremely filthy, and must be largely contaminated with 
human and other impurities. They do not suffer from 
diarrhoea and fever more than others, but rather less. The 
filthiness of the creeks which ramify into different parts of 
the city are much worse than this. He gives one illustration 
of a creek near the foreign settlement which has been under 
his observation for some years. It is narrow, crowded with 
boats — innumerable houses on each side — the alvine dejec- 
tions and other impurities of thousands of inhabitants along 
it are daily discharged into the stream, yet the water, too 
dirty even for washing, is daily used for culinary purposes 
without being filtered, or is precipitated with alum as is done 
elsewhere. Here we should expect the prevalence of such 
diseases as typhoid and diarrhoea among the inhabitants 
occurring often enough to excite attention, but their very 
impunity is one of the reasons for their continuing to use the 
water. He adds, a detailed examination of this creek and 
the disgusting habits of the inhabitants would almost un- 
settle one's ideas of the connection between typhoid fever 
and polluted water. I can myself corroborate every word 
of this as witnessed at Tientsin, in the North, where a similar 
condition of things exists. Or take another witness, Dr 
Reid, at Hankow, in Central China, on the Great River 
Yangtse. Speaking of the same fevers of the intermittent 
and remittent type which are so prevalent in China, the 
latter especially, he says—" The failure to discover any type 
of exanthematous fever is scarcely what might have been 
anticipated, knowing the filthy condition of the houses and 
streets, the density of the population, and the poverty in 
many quarters of the native city. It might have been pre- 
sumed that the haunts of enteric fever at all events would 



have come to light, seeing that the products whence its 
organisms are supposed to be derived and nourished abound 
in many directions. This will be readily acknowledged if 
allusion be made to two of the more active and constant 
sources of impurity — viz., the emanations from the latrines 
and drains. The latrines are of course numerous — con- 
structed without regard to cleanliness, and nothing is used 
to interfere with the results of decomposition. Their con- 
tents are allowed to accumulate for three or four weeks until 
the large, deep open troughs underneath are filled, and they 
are then disposed of to the farmer or gardener and carried 
to the jetties in uncovered buckets, often during the day. 
While the process of emptying the troughs is going on the 
neighbourhood is saturated with odours of the most intense 
description, and which defy the tolerance of even! well- 
blunted olfactories. The boys in an adjoining school, who 
never smelt fresh air, were obliged to have their nostrils 
stopped or compressed during successive days to exclude 
the stench. Notwithstanding the apparent undesirable 
character of the locality, in some pases private dwellings 
and even restaurants doing a thriving business, may be seen 
attached to the latrines, and only separated by a wooden 
partition insufficient to oppose the entrance of polluted ah*. 
The drains are blocked up with accumulations of mud and 
debris. From the want of means to obviate the regurgita- 
tion of gases from the cesspools of the streets, connected 
with the courtyard or interior of the houses, these drains 
must contribute largely towards increasing the impurity of 
the houses. In the poorer quarters the open ditches are half 
filled with decomposing refuse and garbage, and exposing 
their nauseous contents close by the doors or even under 
the floors of the houses." He further adds — " These various 
prolific sources for the development of organic germs have 
been specially referred to in connection with the absence of 
enteric fever, because it may happen that in time evidence 
may he collected to prove or contradict an important theory 
in relation to this fever, that where malaria exists there is 
neutralisation or tolerance of the enteric poison." At Chefoo, 



10 

Dr Meyers reports "that the water is decidedly unsatisfac- 
tory, full of organisms, owing to the total want of circum- 
scribed cemeteries and the water percolating through the 
soil. The surroundings of the wells, moreover, are filthy, 
combined with dirty buckets and dirty water-carriers. Per- 
sons long resident here appear to suffer but little inconveni- 
ence from this state of affairs. There is no drainage, but at 
the same time I must confess that this appears to exer- 
cise no injurious influence over the sanitary state. There is 
total absence of all those deleterious effects which might be 
justly supposed to follow so dangerous a disregard of sani- 
tary laws." Amoy, according to Drs Miiller and Manson, is 
superlatively dirty, streets narrow, irregular, and filthy in 
the extreme, and redolent of every impurity. Pigs and dogs 
are the sole representatives of the elaborate machinery of 
sanitation in use in European towns, and a scientific sani- 
tarian, with only home experience to guide him, would con- 
fidently predict the origin of epidemics and death. Yet the 
Chinese manage to live and thrive where he would hardly 
dare lodge his pigs. There is no typhus, no typhoid, or 
other disease, considered the inevitable consequence of de- 
fective sanitation, although Amoy, and indeed all Chinese 
towns, are full of typical typhus dens. Luckily filth, over- 
crowding, and bad. food are not the only factors necessary 
for the manufacture of a typhus epidemic. Were they so we 
should live here (China) in perpetual dread. - And these are 
not the only fevers whose absence we have remarked, with 
the exception of smallpox, we have met with no representa- 
tive of the class of continued fevers which claims so large a 
number of victims in Europe. No case has been met with 
in either Amoy or Formosa of scarlet fever, measles, relap- 
sing fever, or diphtheria. The petechial fevers, with the 
exception mentioned, are entirely awanting. Considering 
this and reflecting on the rarity of the atheromatous and 
fatty degeneration, with the numerous dangerous diseases 
they entail, we may be at a loss to account for the mortality. 
If we think, however, of smallpox mortality, 1 in 3 from the 
unmodified form, part of the difficulty vanishes, and then add 



11 

malarial diseases, remittent fever, ague, diseases of the spleen 
and liver, anemia and its consequences, and to these add 
cholera and leprosy, and we have sufficient causes for a con- 
siderable mortality. Another writes (Mr Porter Smith, of 
Hankow) — "Chineseutter disregard of sanitary science among 
an otherwise highly civilised and accomplished race is one 
of the worst facts. They take kindly to the purple, but 
never to the fine linen. The cleanest and whitest garment 
next the skin would be a strange perversion of the order of 
wearing their apparel, but nevertheless they possess public 
baths." 

Dr Somerville, of Foochow, a graduate of our University, 
says : — " I have to add my testimony as to the total disre- 
gard of anything like sanitary arrangements. Dirt of all 
kinds finds its way through the non-dovetailed and shrunken 
planks of the floor, and when a house is burnt or blown 
down, the foundation is seen to be a mass of filth in a decom- 
posing state. There is nothing like drainage, and the traffic 
in night soil, the formation of manure pits, and the watering 
of fields with liquid ordure obtain here as elsewhere. In 
short, we have all the generally recognised factors of 
zymotic disease, with a high temperature to favour the 
fermentative and putrefactive processes. Yet we enjoy a 
high standard of health, and there has been no epidemic 
affecting foreigners at this port for at least eleven years." He 
was led to make these remarks by the remarkable fact, that 
four cases of typhoid fever occurred during 1872-73. There 
had been no case at the anchorage for three years, and in 
eleven years' practice there he had seen only seven or eight 
cases altogether before the present series. There was no 
evidence that the fever had been communicated from one 
patient to another, and he sets down the form therefore as 
sporadic. He adds, " We have a mass of evidence favouring 
the view that the poison of typhoid is communicated 
through contaminated water, and I think that cases like the 
present, where no such mode of diffusion is probable, are 
deserving of record." And he further adds, very cautiously, 
as if he felt misgivings about the received connection 



12 

between contagion and the communication of typhoid, as 
explaining the whole case : " I think the purpose of these 
reports (Customs' Half-Yearly Medical Keports) for the 
present is best served by collecting material for future use. 
I, therefore, content myself with stating these facts, and 
refrain from generalising from them, more especially as the 
subject of sanitation is at this moment engaging the atten- 
tion of our best authorities in all parts of the world." 

The foregoing remarks hold good regarding all large 
native cities. Drains for surface water are general in 
Chinese towns, but, for the most part, they have been 
allowed to get choked up and broken down, and then they 
become the receptacles, as open ditches, of the city garbage 
and filth, and become a terrible nuisance. The condition of 
the capital resembles, in many respects, other Chinese cities, 
but in many important particulars it is quite different. In 
regard to drains, Pekin stands unrivalled among the cities 
of the world as far as their age, extent, former admirable 
adaptation and present ruinous condition are concerned. We 
have two large sewers on all the main streets, with branches 
to all the lanes. They drain into the city moat, and these 
into the Peiho, or canal leading thereto. Those that are free 
in parts of their course are sure, after heavy rains, to open 
somewhere into the streets, deluging them with putrid mud 
and filth, entering the drain at a distant point, and then 
again repeating the above act. By and bye the mud dries, 
and is used for repairing the roads. With all our filth and 
dirt there is a wonderful immunity, even from fevers. The 
police, who water our streets from these cesspools, and 
utilise the dirty water and urine collected in the houses 
and shops during the day, are among the most robust, 
and,' healthy of our population, provided they are not, 
at the same time, opium smokers. The beggars, a very 
numerous class, who sleep in the streets nearly all the 
year round, congregate in the very centres of pollu- 
tion, and even, to some extent, contest with . dogs, priority 
of claim to the refuse of the dunghill, not only survive, but 
flourish, and most of them look fat and sleek. The mouths 



13 

of our lanes, waste places, and tumble-down, or unoccupied 
houses and shops are our most pulluted regions, and the 
common place of resort of the neighbourhood for males. 
The reason assigned for the innocuousness of this sad con- 
dition of things in China are, among others, the following : 
— There are our prevailing winds in most parts of China, 
which act as diluents, and prevent the too great accumula- 
tion of noxious effluvia, ready to ripen into activity. There 
is also the sandy, absorbent nature of our soil, in the North 
at all events. The apparently objectionable and disagree- 
able plan of watering the streets from the foul fluids of the 
drains and domestic urinals carries good in it. These 
collections of decaying organic matter are moved and pre- 
vented from accumulating in too large quantities, and when 
thrown on the streets the greater part of it is absorbed by 
the dry soil. The operation is always performed after sun- 
down, to prevent too much evaporation. I am unable to 
say whether this is from economical or sanitary considera- 
tions, most probably the former. After sunrise the streets, 
are nearly as dry as before. Our weather is very dry in the 
North, frequently seven or eight months without either rain 
or snow. In summer, after heavy drenching rains of several 
inches, the dust will be plentiful on the third day, so dry 
and absorbent is the soil. Another reason, and this is 
doubtless the chief one, is the high value of human manure, 
and the assiduity therefore with which it is collected for 
agricultural purposes. Large numbers of the people in this 
way obtain a living. Its high value and the great poverty 
of the people are our safeguards. It is carried outside the 
city walls, and is dried and caked, or pulverised. The dung of 
the herbivorous domestic animals is dried for argol, and used 
as fuel. Human excrement so prepared is the most expensive 
of manures. Much that is recommended at home in the way 
of ventilation, water supply, and disinfection of privies is 
in China rendered unnecessary. All the advantages claimed 
for the dry earth system are gained here free of expense to 
the individual or public. The industrious and frugal habits of 
the Chinese, and even their very poverty, thus work to their 



14 

advantage (all sanitary measures more than repay their 
cost), for it compels them to utilise all excrementitious 
matter. Every particle of every kind of manure, besides 
rags, paper, etc., are collected and preserved with the 
greatest care. The private privies, which are all out of 
doors, are visited daily by these manure collectors, and so 
great is the demand for it, that ho payment is made to these 
scavengers. Foreigners pay a trifle monthly to guarantee 
respectability, cleanliness, and regularity on the part of the 
collector. The healthiness of our foreign settlements in 
China is, in a great measure, owing to the absence of water 
closets in the dwelling-houses, which, in Europe, are a fruit- 
ful source of disease. Gases, such as sulphuretted and 
carburetted hydrogen, are not so injurious to health when 
given off in the open air, as when escaping from sewers. 
China is, par excellence, the country of bad smells, and yet, 
as we have seen, the people do not seem to suffer from 
them, but, on the contrary, rather like them. 

The removal of excreta and the disposal of sewer water is 
the sanitary problem of the day in this country. Our sewers 
allow transference of gases and organic molecules from house 
to house and place to place; occasionally, by bursting, leakage, 
or absorption, the ground is contaminated, and the water 
supply is constantly in danger of being poisoned and con- 
taminated ; and all these dangers are greater from being 
concealed and being beyond individual control. Fevers and 
cholera are thus possibly propagated from house to house. 
In China we are entirely free from this danger. It would 
seem advisable that our water closets should be in an out- 
building or projection from the main house, and should be 
placed at the top of the house, with a tube passing to the 
outer air. When placed in the basement the closet air is 
certain to be drawn into the house. For use in the bath 
room, a solution of sulphate of iron 4 parts, carbolic acid, 1 
part to 30 parts of water, has been recommended as a good 
disinfectant by Dr Jamieson. Each time it is used two 
ounces of the solution should be poured in. By this means 
the air would be rendered perfectly pure, or at most faintly 



]5 

impregnated with carbolic aeidv Tka great expense at- 
tending the use even of the cheapest disinfectant would 
seem to preclude the use of this method for the large sewers 
of our cities. This, however, is denied, and it is asserted 
that certain antiseptic agents, even in a highly diluted form, 
would gain the object in view. It does not seem impossible 
in large manufacturing towns to ventilate the sewers by con- 
necting them with factory chimneys. These same chimneys, 
as well, probably, as those of ordinary houses, in seasons of 
epidemics at least, or by spray-producing machines or other 
mechanical appliances, might disinfect closes, houses, and 
whole localities and towns. 

Houses. — Let me now say a few words about houses in this 
connection. In China they are, with few exceptions, of only 
one storey. The streets are narrow ; those in the capital are 
an exception to this rule. These narrow streets serve the 
purpose of warding off the great heat of summer — mat 
awnings being frequently stretched across them ; in winter 
they protect equally from cold winds and increase the 
general warmth and comfort. The houses are, as a rule, 
arranged in courts, the principal ones invariably facing the 
south, by which they get the cool winds in summer and the 
warmth of the sun's rays in winter. The houses of the 
better classes of officials, temples, &c, are lofty and hand- 
some. The> arrangements of the houses, required by their 
style of architecture and family relations, necessitate numer- 
ous courts, and thus cover a considerable area. No houses 
infringe on the privacy of others. They are usually sur- 
rounded by verandahs, rendered necessary by the great heat 
of summer. The better class are built of substantial brick, 
the poorer ones, and especially in the country, with sun- 
dried bricks. The roofs are massive, being covered with 
closely-overlapping tiles, with a thick layer of mud and lime, 
and with wood, slate, or straw underneath, which effectually 
keeps out the cold in winter and the heat in summer. Venti- ■ 
lation is perfect in summer, but rather defective in winter. 
The poor people like to have low ceilings to lessen the space 
to be heated. The houses visually consist of two brick gables, 



16 

with the other two sides filled in with windows and doors. 
With the exception of the introduction of our chimneys and 
wooden floors, foreign changes have not been improvements 
on the best sort of native houses. Our houses, all under one 
roof and of several storeys, with the exception of economy, 
perhaps, in heating, are liable to serious objections in the 
matter of fresh air, free ventilation, and, if need be, isolation. 
The better class of houses are usually raised several feet 
above the ground, and the surrounding courtyards being 
thus lower, afford excellent drainage in rainy weather. In 
China there are no sunk flats or cellars. The foundations are 
usually of stone, and the lower parts of the corners of the 
gables and cornices are also of this material ; all the rest is of 
brick. In the country the sun-dried brick houses have almost 
invariably a band of slate, wood, or more frequently straw, 
running round the house, to prevent the damp ascending and 
mouldering the bricks. The plan proposed of having a 
chamber in the foundations of the houses in this country 
communicating with the chimneys from the lower storey, and 
where they would begin, is, I think, strongly advisable, and 
would thus ensure that all foul gases and diseased germs 
arising from the soil would be carried out of the house. To 
prevent the ascent of air from the soil, the basement should 
be paved or concrete used, or, as lately recommended by Dr 
Richardson, the houses should be raised on arches. Chinese 
houses and courtyards, of the better class at least, are floored 
with brick, which prevents emanations from rising, the 
water in the courts from being absorbed to any great extent 
and tends greatly towards draining off the rain water. 
From -the condition of the great bulk of the houses of the 
lower classes both in town and country — the houses having 
earth floors and a damp subsoil under or around them — 
we should, of course, expect rheumatism and neuralgia to be 
very prevalent. And so they are. Among the Mongols, 
living in tents, rheumatism is the most commonly met with 
affection. The cases, however, are entirely muscular, the 
acute variety being rarely heard of, and one practitioner 
states never met with, although frequent enquiry was made 



17 

amongst the Chinese sufferers. The causes of chronic 
rheumatism are not far to seek in a population lowered by 
malaria, bad diet, damp dwellings, and especially great and 
sudden changes of temperature. The absence of the acute 
form is attributed to the rapid elimination through the skin, 
and likewise also to the more sluggish, inactive disposition 
of the Chinese, rendering the system less liable to be roused 
to produce acute symptoms. Another professional brother 
reports at his port " rheumatism takes almost invariably the 
chronic form, caused by the damp and undrained situation of 
native houses." Dr Smith, of Hankow, thinks the vegetable 
diet, poverty of nitrogen in rice, and scarcity of red flesh 
tend to its development. At Newchwang, Dr Watson reports 
— " The people suffered from rheumatism and ague after the 
heavy rains, but in spite of insufficient food and the un- 
healthy character of the country, no very great increase of 
mortality among natives took place during the summer." 

The warming of houses is another point of importance. 
Chinese houses have no chimneys. In the North of China, 
where the winter is long and severe, the houses are provided 
with kangs, or earthen platforms, covered with large square 
bricks, having flues running under them through which the 
heated air and smoke, if any (for they burn anthracite coal), 
passes, and after traversing the kang finds an exit in front 
into the room, and uniting with the heat of the fire, increases 
the heat of the room. Among the upper classes these bed 
platforms are sometimes heated from the outside, which is 
a decidedly preferable plan. The floors, too, are sometimes 
heated in this way, the flues being arranged under them in 
the same way and heated from without. This union of 
kitchen, fireplace, and bed is a matter of great moment to 
the poor and the delicate, whether young or old, who suffer 
greatly from insufficient clothing and improperly or im- 
perfectly heated houses. Among the very poor it dispenses 
with much bedclo thing. The bedclothing of such consists 
generally of their every-day wearing apparel loosely laid 
over them at night, with the addition of a cotton mattress. 
They sleep with the head to the outside of the kang, the 



IS 

reason assigned being that in this position it avoids the 
danger of the clothes catching fire, and puts the head— the 
heavenly part of man--in a freer and more honourable 
position. "With the head to the wall the impure air and 
feeling of restriction and confinement would prove injurious. 
We have at Pekin several beggars' houses or small inns 
and an Imperial House of Refuge so heated in the winter 
season. The latter is gratuitous, and a very small pittance, 
about a farthing for a night's lodging, is demanded by the 
keepers of the former. The windows are well papered and, 
oiled. In the centre is a large fireplace for warming the 
room and the beggars, and supplying them with hot water. 
The beggars squat or lie down on the stove bed-places, with 
simply a mat stretched upon it, and they without any bed- 
clothes, in fact generally without any clothes at all. I have 
seen as many as fifty, each bolstering up his neighbour, on 
such a kang. The temperature is kept about 70°. The air 
of these rooms is, of course, extremely disgusting, but 
they are tolerably clean. During the day the beggars, who 
for the most part are fat and well-looking, pursue their pro- 
fession on the streets of the city, and at night again return 
to their heated ovens. Although the atmosphere in these 
places is loathsome, it is still a matter of great consideration 
that they are able to obtain lodging in a warm room for the 
night when the thermometer is often near zero, especially 
when they have no blanket or coverlet to protect themselves. 
In some places a coverlet suspended from the roof is let down 
upon them at night. The mortality in the Imperial House 
of Refuge is very great. In the latter place the beggars are 
supplied with two meals of millet per day. 

From this description you will observe that the Chinese 
houses and bed-places in the North, at least, closely resemble 
the Roman hypocaust, the floors being warmed by pipes and 
smoke flues under them. A plan similar to this might very 
beneficially be introduced into our own country in one-storey 
houses or the basement floors of others. In winter these 
kangs would prove eminently serviceable for the very young 
and delicate of whatever age among the poorest classes who 



19 

cannot afford either sufficient clothing or bedding. They 
might be so arranged that our bitumenous coal would prove 
no drawback, and I feel certain that our great mortality 
among certain classes from bronchitis, pneumonia, pleurisy, 
congestion of the lungs, &c, "would be greatly lessened. 
The pawnshop, and afterwards the ginshop, are too often 
the receptacles of the clothing charitably dispensed to the 
poor in winter. The frugal and economic Chinese, if placed 
in our position here, might even consider the propriety and 
feasibility of utilising the waste steam of our great factories 
for heating the dwellings of the neighbouring poor. The 
American cylinder stoves, now so universally used by 
foreigners in North China, are well adapted for heating 
purposes. They heat thoroughly, and are greatly to be pre- 
ferred to the extravagant and poorly heating English fire- 
place. The water evaporating apparatus provides against 
headache, &c, from overdryness of the atmosphere. Chinese 
houses are on the whole well lighted, two sides being almost 
always composed of doors and windows. The light is well 
diffused, and there is no glare — oyster shells in the South, and 
Corean or other paper in the North, being the article with 
which the windows are glazed. Glass is being extensively 
introduced. An important factor in the health of the 
Chinese is their being so much in the open air. The male 
portion of the people, even those of our own profession, in- 
cluded along with the barbers and chiropodists, carry on their 
trades and callings on the public streets. They live much 
in the streets and in the open air — the whole side of their 
shops being freely exposed. In this way many of the evils 
and dangers of our crowded workshops, arising from impure , 
air, from whatever cause, are avoided. 

Water Supply. — Another topic demanding a passing notice, 
as playing a most important part in sanitation and causation 
of disease is the water supply. The water supply in China is 
derived chiefly from rivers and wells. The water obtained 
from rivers is manipulated in various ways, passed through 
filters, allowed to settle, and the organic matter is preci- 
pitated by chemical agents, alum being in most common use. 



20 

But whatever be the water, and wheresoever the supply, it 
is invariably boiled by the Chinese. The Chinese, as a rule, 
do not drink cold water. We have already pointed out how 
strongly it is contaminated with filth and garbage in the 
great centres of population on the great rivers, and that the 
supply is almost invariably drawn from the public places of 
resort. In Pekin the supply is partly from wells and partly 
from springs at the Summer Palace Gardens, the water being 
led into the city, a distance of eight or more miles, in a 
canal. It runs through lakes, and ultimately through the city 
moat. Our ice supply in winter is derived from this quarter. 
The water is soft and sweet, and is equal to our Loch 
Katrine water. The well's in the city are numerous, and 
placed at short distances, generally on alternate sides of the 
streets, from which the neighbouring householders, who have 
not wells on their own compounds — and nearly all large com- 
pounds have one or more — and animals are plentifully sup- 
plied. The refuse water at these wells is used for watering 
the streets. Wells are to be found along all the roads of 
China at every short distance to supply the wants of travel- 
lers and the domestic animals. The wells are usually farmed 
out. The water-carriers have their legs bandaged from the 
knee downwards, with the object of strengthening and sup- 
porting their calves, and so aiding them in following out 
their occupation. The device is effective against varicose 
veins, or as they express it, " the falling down of the belly 
of the legs." Varicose veins are very uncommon among the 
Chinese. Ignorant of the true circulation, they suppose 
them to be tendinous tumours, and so express them. May 
not the practice of tight garter-tying, among the fair sex 
especially, obstructing the circulation, cause this condition 
of things, which is pretty common in the West ? The Chinese 
tie their trousers and stockings together at the ankle with- 
out any bad results, and with the additional advantage of 
keeping in the heat and keeping out the cold. From the 
universal prevalence of water and these wells, I need hardly 
say that rabies is extremely or comparatively rare, consider- 
ing the vast number of dogs, each householder possessing 



21 

one or more. Dogs are never muzzled. Gravel and cal- 
culus, too, are among the rarest of affections in China., 
Only in Canton has calculus been found at all, and there it 
seems to exist to a considerable extent. The reason has 
not yet been explained, for the same conditions, river water, 
boiled and used in cooking or in infusion of tea, are univer- 
sal over China. In Canton, from 1854 to the end of 1875, 432 
cases of stone were operated upon at the Mission Hospital 
there. The total weight of stone removed was 408 ounces, 
or 25£ lbs. The gouty diathesis appears to have little to do 
with the prevalence of stone at Canton, as gout is not met 
with among the native population. And not only is stone 
absent, but all other urinary or aenal diseases are compara- 
tively rare, certainly much less common than in Europe. 
Only one case of diabetes was seen at Hankow in five years 
out of thousands of patients. This immunity from renal 
disease is attributed to some extent to opium. But opium 
smoking, although very prevalent, and the consumption of 
the drug increasing and extending, can only explain this 
freedom from renal and other diseases to a limited extent. 
We shall point out further on some other and more evident 
reasons. The original badness and filthiness of the water at 
the open ports on great rivers and adjoining large native 
towns — and, as a rule, the foreign concessions are situated 
below the native cities — has frequently been made the pre- 
text among our countrymen out there for indulging in vari- 
ous medicated waters. The seductive cocktail and brandy 
and soda, &c., &c, in a warm climate, and with high animal 
living, have had much to do with the high foreign death-rate 
— liver disease, aneurism, heart disease, heat apoplexy, &c, 
of which we hear from time to time. There is no doubt that 
the best treatment to which to subject all water, especially 
where there is any suspicion, is to boil it, and by so doing 
to destroy all the living organisms. If we must swallow 
myriads of insects in almost every drop of water, it is as 
well that they should be cooked. It has been established 
that living protoplasm is certainly destroyed by sudden ex- 
posure to a high temperature, say 140 F. when in the moist 



22 

state. It is only for a very few minutes that contagious 
matter can stand the temperature of boiling point — its 
destruction is merely a question of sustained boiling. And 
it cannot be too distinctly understood that dangerous quali- 
ties of water are not obviated by the addition of wine or 
spirits. I certainly think that we, as a people, and still more 
our American brethren, drink too much cold water. The 
Chinese, who have seen foreigners drink down large tumbler- 
fuls of water at meals, attribute it to the necessity of putting 
out the fire in the stomach caused by our beef-eating pro- 
pensities. The Chinese have water freely exposed in their 
earthenware utensils or kangs. They tell us never to drink 
water on which the sun ha* shone, no matter how thirsty, 
for besides that it hath at that time pernicious qualities, it 
is often full of the spawn or ova of innumerable insects. 
Simple hot water and tea are the common every-day bever- 
ages of the Chinese. The universal use of hot water as a 
beverage is remarkable. Our own old writers on health 
have also recommended as an immediate remedy in flatu- 
lence and palpitation of the heart, and indigestion gene- 
rally, the use of hot water and the recumbent position. 
u Cold water is an enemy to concoctions, and the parent of 
crudities." And here, as in other matters, it would be well 
always to remember that before the process of digestion can 
commence, the matters introduced into the stomach must 
take the temperature of that organ. And the experience of 
not a few will doubtless corroborate the Chinese practice, 
that when overheated, physically fatigued, or mentally ex- 
hausted, a glass of hot water will refresh them more than 
wine ; the latter exasperates the evil, the former mitigates 
it by its softness and coolness. It might probably be sup- 
posed that owing to this extreme care, observed by all 
classes regarding water, intestinal worms would be very 
infrequent in China. The reverse, I am sorry to say, is 
the case. The tape and round worms are very common — 
male-fern in the former, and santonine lozenges in the 
latter, have been most successful remedies. Numerous 
patients have been relieved of several tens of feet of the one, 



23 

and hundreds of the others. They are supposed to cause 
toothache, necrosis, consumption, &c. ; and the native treat- 
ment is always, of course, directed against this supposed 
cause. Both the taenia and lumbrici are supposed to be 
caused by eating macaroni or vermicelli, and the native 
faculty strictly forbids the use of these substances, which 
seem in the system to be converted into worms. The people 
everywhere indulge in pork, raw vegetables, unripe and 
uncooked fruit, and, I presume, the animals are carried into 
the system through these channels. The taenia solium, 
which is so prevalent, is certainly owing to the consumption 
of pork, imperfectly cooked or quite raw ; for we know that 
the cysticercus cellulosa, the embryonic state of the taenia, 
exists in the pig. 

Baths. — A word as to Baths. Numerous public baths exist 
in all large Chinese towns. They are known during the day 
by a red lantern, lighted at night, raised on a lofty pole. The 
water is usually changed once daily. The utmost care is 
■exercised in admitting to the baths. The floors and the 
baths themselves are heated from underneath by stoves. 
Private baths in wooden tubs may be had to order. An 
ordinary bath costs Id, and during the last month of the 
year about 3d. Cold bathing is never resorted to, and it is 
to this use of warm water, to their temperate habits, and 
partly also to their non-use of flannel, that we must attribute 
the absence of prickly heat (lichen tropicus) in summer. 
Europeans are greatly afflicted by this troublesome eruption, 
the sensibility of the skin being greatly increased by stimu- 
lants. The looser garments of the Chinese may also 
operate beneficially. The Chinese are not much given to 
baths. A little water satisfies them ; for their ablutions they 
are content with just as much scalding water as will cover 
the bottom of a flat brass basin. The greasy commissioner 
Yeh, on his way as a prisoner to Calcutta, indulged in a bath, 
truly a la Chinoise, when he called for a teacupful of warm 
water. They never wash their hands or face with cold 
water, but use a loosely woven cotton handkerchief or 
cloth, wruag out of hot water, with which they wipe their 



24 

hands and face in the morning, and also after meals in good 
families. The Chinese dread the effects of water, especially- 
cold water. It would be cruel to think of disarming the 
beggars of their foul coat by means of a hot bath, because 
they would certainly die from inability to resist the cold. 
The thievish air would gain admittance at every pore. As 
practitioners, we must eschew water dressings, baths, fomen- 
tations et hoc genus omne, if we wish to remain in attendance 
and inspire respect and confidence. The people abhor not 
only the touch, but the taste of cold water. The Chinese 
suppose Europeans are obliged to .bathe daily on account of 
the insupportably bad odours which are emitted from their 
cuticles. Hot or warm baths, especially in tropical countries, 
are by far the safest and really the most cooling in summer. 
The strong reaction after a cold bath makes the feeling of 
heat tenfold worse. There are various diseases, especially 
of the liver, where cold bathing might prove dangerous, as 
tending to congestion of internal viscera, and which are there- 
fore contra-indicated. 

Beverages. — Speaking of the water supply, leads me 
naturally to speak of the beverages or drinks of the 
Chinese, and here also there are some useful lessons 
for our guidance to be learned. The Chinese are a sober, 
temperate people. Although China has much fermented 
liquor, she has neither beer from malt, nor wine from 
grapes. She is emphatically a sober country; though 
wine is cheap, and there is no tax upon it, and no re- 
striction in its sale or manufacture, and though nearly all 
classes use it, few 'comparatively drink to excess. That 
which is the common disfigurement of life in our cities and 
towns, is a rare sight in China, even in her seaports. The 
rice wine, not unlike our sherry or Cape, is served up hot 
in small cups — the common spirit or samshoo, distilled 
usually from millet, is never heated. Taking our drinks hot, 
besides being more natural and rendering them easy and 
ready of absorption, we know what we are doing, not like 
iced wine which people are induced to drink, deprived of 
the advantage of knowing when they have got enough. It 



25 

is indeed a very rare thing to see a drunk Chinaman, and a 
drijnk woman would be a wonder. During a residence of 
twelve years in the country I have not seen five cases of 
intoxication. And yet the Chinese, apparently so abstemious, 
consume no inconsiderable quantity of spirits. The great 
consumption of spirits in Western countries is often offered 
as an apology for opium-smoking in China. There would be 
force in this argument if China abstained from intoxicants, 
for in addition to her opium and spirits, she has also her 
stimulating tea, betel nut, and tobacco. But although a 
little spirits is usually consumed after meals nearly all over 
China, the very badness and want of fragrance of the native 
spirit, which contains much fusel oil, has kept the people 
sober and temperate. In no country perhaps is wine, of a 
decidedly intoxicating nature, so generally and yet so mode- 
rately partaken of as in China. I have seen not a few cases 
of dyspepsia and stricture of the oesophagus caused by addic- 
tion to spirits, the latter cases of course uniformly fatal in 
the long run. The only treatment which the Chinese have 
devised for this formidable complaint is bread saturated 
with the blood of decapitated criminals. The absence of 
renal and hepatic disease is referred in part to their com- 
paratively temperate habits. "With tropical heat in sum- 
mer, the variableness of the weather, particularly in spring 
and autumn in most places, the poverty of the people, and 
their general exposure to the inclemencies of the seasons, it 
is remarkable to find hepatic disease so rare. Great care in 
preserving from chills, an object easily obtained, as we shall 
see, by the nature of the Chinese clothing, along with 
proper diet and temperate habits, are the chief prophylactic 
means against "liver." We find the Chinese, too, almost 
absolutely free from diseases of the heart and blood vessels 
— fatty degeneration, for example, which is the usual form of 
heart disease induced by alcohol. We have noted the 
absence of serious changes in the liver and kidneys, as, 
for example, diabetes and Bright's disease. Delirium tremens 
is also unknown in China. 

And here allow me to make a very few observations 



26 

on aneurism, heat apoplexy, and syphilis in- this connec- 
tion. Aneurism, as we all know, is of increasing fre- 
quency in England. During the last 20 years the total 
number of deaths have been more than doubled, and they 
have been wholly confined to males above 20 years of age. 
There has been no increase among females or young people. 
Heart disease and aneurisms are now among the most ap- 
pallingly frequent diseases of early manhood. The profes- 
sion has been greatly exercised in the East to discover 
causes of degeneracy among the Europeans in the prime of 
life. French surgeons ascribe it to changes caused by 
malaria. As a cause leading to degeneration, syphilis, by a 
pretty common consensus of opinion, occupies a foremost 
place. Rheumatism and alcoholism are said to produce the 
same arterial inflammatory changes as syphilis. With the 
Chinese, and rice-eating people generally, aneurism is the 
least common affection. In Shanghai, our principal port in 
China, the ratio of deaths from disease of the heart and great 
vessels, to the number of deaths from all causes, is higher 
than in Europe. In 1873 there were 7 deaths at Shanghai, 
7 in 6 months of '71 and '72, 5 in '72, 16 in 3 years. No case 
has of late years, at any rate, been seen at the Chinese hos- 
pital in Shanghai. The simple habits of living of the Chinese, 
their phlegmatic and unexcitable natures, probably give 
them immunity from this disease. 

Our present high-pressure European life, with its mental 
overwork and incessant worry, intensified by other influ- 
ences, nearly if not quite as potent, such as excessive use 
of alcohol, inattention to diet, pure air, and by animal 
excesses, must have much to do, I should think, with heart 
disease and aneurism, not to speak of such other affections 
as paralysis, dementia, diabetes, and renal disturbance. 
This overwork and over-anxiety, by the very exhaustion of 
the body which they cause, call for stimulants, and soon other 
diseases set in which too frequently place the patient beyond 
medical skill. Physical overwork is also characteristic of 
modern life. Excessive physical exertion is quite unneces- 
sary to maintain or promote health. The 1000 miles in 1000 



27 

hours sort of exercise , numerous of our games and exercises, 
such as foothall, boxing, rowing, leaping, running, &c, in- 
dulged in to an extreme degree — and I fear such is only too 
truly the case — are well adapted to increase over-action of the 
heart, and consequently subject the individuals to frequent 
and sudden congestion of the lungs and other vascular 
organs ; to aneurism, at one time called post-boy's malady, 
hypertrophy of the heart, &c. When extra force is put 
forth it is too frequently at the expense of the organism it- 
self. We have also a combination of the mental and physi- 
cal, so well brought out in Dr Richardson's work on the dis- 
eases of modern life, as exemplified in long journeys to and 
from business — our railways facilitating living out of town 
away from oflice and places of business. There is the rush- 
ing to catch a train morning and evening, a mode of life 
possessing many elements of danger and many annoyances, 
and in this way both the nervous and vascular systems 
suffer. To the former belong unnecessary anxiety, restless- 
ness, timidity, and sleeplessness, irritability of temper, recur- 
ring fits of exhaustion ; to the latter irregularity of the cir- 
culation, irritability of the heart, cold extremities, imperfect 
secretions, want of muscular power — a host of circumstances 
connected with railway travelling which contribute to injure 
and shorten life and comfort. I might have referred here to 
other causes all tending in the same direction, such as poli- 
tical excitement, excitement of war, religious revivals, con- 
tests of creeds, speculations of philosophy, publication of 
daily newspapers, the flashings of the electric telegraph, and 
other such like influences, from all of which disturbing 
and disease-influencing and disease-producing causes in 
China we are fortunately completely free. 

Some of our Chinese maxims bearing upon the heart and 
its affections are the following : — Do not employ yourself in 
any thoughts and designs but what lead to virtue ; keep 
peace in the heart (anger and sorrow are supposed to 
damage the internal viscera, injuring the liver, and thereby 
preventing the secretion of the active principle of the blood 
and the source of the vital spirits — injuring the lungs, and 



28 

thereby causing haemoptysis, and finally consumption, and 
paralysing the oesophagus and stomach) ; besides, reflect 
often upon the happiness of your condition — know the value 
of health, and study to preserve it. 

I have referred to anger, and here, in passing, I would 
remark that the Chinese themselves trace almost all their 
diseases to anger or to wine. The former stands first. That 
man is indeed rich in physical power who can afford to be 
angry. We hear of and often see people red or white with 
rage, and as a result of this, when long-continued, intermit- 
tency of the heart, paralysis, apoplexy, congestion of the 
liver must ensue. 

Regarding heat apoplexy, in 1872 no fewer than ten deaths 
occurred at Shanghai. Intemperance is recognised by all 
as- a powerfully predisposing cause. In regard to these 
cases, it was found on enquiry that in nearly every instance 
these patients indulged freely in alcoholic liquors. The 
dangerous effects of exposure arc controllable by proper pre- 
cautions and by prudence in eating and drinking. Insola- 
tion is quite unknown among the natives, even among 
labouring classes, who go through severe physical exertion, 
and often with their heads quite unprotected from the 
sun. 

A word or two on syphilis in this connection may not be 
inappropriate — "that one moral and physical blot of our 
civilisation, tinging many diseases, if not causing some, pro- 
ducing many forms of cachectic feebleness and impaired 
physical build, probably the most controllable, but at the 
same time the most prolific of injury." Our profession re- 
cognises this disease as predisposing to arterial degenera- 
tion — the so-called syphilitic arteritis. The diseases of the 
heart and blood vessels among our troops in China and 
Japan have been traced to this cause. There is in the army 
an excessive mortality and invaliding from aneurismal dis- 
ease, said to be developed in China. The virus of syphilis 
is said to be more violent and severe there than the same 
disease when contracted in Europe. There may be other 
reasons in diet, intemperance, and exposure, to account for 



29 

this. Syphilis is, more frequently met with in private European 
practice in the East than in England. But I should think 
that diseases resulting from vicious and licentious habits are 
not so violent in their effects in China as in countries where 
the use of animal food and higher living render the system 
more susceptible to the noxious consequences of the virus. 
1 have seen hundreds of cases of patients with syphilis and 
enthetic disease generally at Pekin, and bad though they 
undoubtedly were, I suppose they were not worse than what 
may be seen here among our lowest classes where cleanli- 
ness is not next to godliness. I have always found the 
Chinese cases most amenable to treatment. I have come 
across not a few cases of cancer of the penis resulting from 
unclean connexion. There is no doubt that cases of phy- 
mosis, on account of the irritation set up by the discharges 
and secretions inside the prepuce, predispose to epithelial 
cancer of the penis. All the cases I saw, and in most of 
which I operated, had this origin. Strange to say, one of 
my patients was a Mohammedan who had not been circum- 
cised in youth. It was interesting to me, as tending to con- 
firm the view advocated by Travers, that the Jews (and he 
might have added the Mohammedans also) know nothing of 
this disease. This immunity is attributed to the beneficial 
results of circumcision. And in these days when so much is 
spoken and written about our Contagious Diseases Acts, it, 
might be well to have recourse to the alternative of circum- 
cision. I feel sure it would be attended with the best results, 
and would diminish very largely all the various diseases of 
the genital organs, and would abolish altogether phymosis, 
paraphymosis, and cancer of that organ. 

After this long digression, I return to the question of 
beverages. Wherever European civilisation has gone, intem- 
perance among the native raceshas followed. We have invari^ 
ably impressed them with our bad example. It is so in China 
to a small extent already at the ports, and we know that the 
Hindoos, formerly the most temperate of races, and in whose 
ordinary food spirits form no part, if indeed they are not for- 
bidden by their religion, are rapidly becoming addicted tp 



30 

drink. Those who are best able to judge condemn alcohol 
as a preventive against cold, and equally so against heat. 
The heat of the tropics is not so well borne where spirits are 
indulged in, and they certainly predispose to insolation. 
Warm tea in the tropics is admitted by all to be the best 
beverage, and the experience of several hundred millions in 
China confirms this opinion. Spirits are no necessity in 
health, and as now used by mankind they are infinitely more 
powerful for evil than good, and a clear view of their effects 
must surely lead to a lessening of their excessive use which 
now prevails in this country especially. In the words of the 
late Dr Parkes — " There is no question that more disease is 
directly and indirectly produced by drunkenness than by 
any other cause, and that the moral as well as the physical 
evils proceeding from it are beyond all reckoning, and yet 
the attempts of the Legislature to set some bounds to 
intemperance have been and are opposed with a bitter- 
ness which could only be justified if the degradation and 
not the improvement of mankind was desired." As a 
matter of public health, it is highly important that our 
profession should throw its great influence into the scale 
of moderation. 

Tea and iced beverages, indulged in by the Chinese in 
summer, such as acidified apricot or rice conge or soup, are 
certainly preferable to all the so-called " gently stimulating 
liquids." They never take milk— there being no pasturage or 
cows except for ploughing, milk has never become an article 
of diet with the Chinese. Among the Mongols — the nomadic 
tribes of the North — milk of course is a chief beverage. Hot 
water alone is plentifully drunk all the year round, but tea 
is par excellence the beverage of the people. It is most 
commonly taken very hot, and always made by using and 
adding to it well boiled and boiling water. This seems the 
secret of making good tea, apparently so little understood 
out of China and Russia. -And we should not so often have to 
complain of bad tea if we were more careful about the quality 
of the water. Its stimulant and restorative action are aided 
when drunk hot. It is followed by no depression, and ought 



31 

to be much more extensively used, and not as a meal — I ought 
to say never as a meal — as is so frequently the case three or 
four times daily by our factory girls and poor classes, and 
which is productive, when so used, of the very worst results. 
The Chinese drink it very frequently during the day, and it 
is always offered to guests on entering a house, but it never 
takes the place of a regular meal. Resting places exist 
every few miles, or more frequently, all over the coun- 
try along the roads, where the tea the Chinaman loves 
is to be found. Many of our people, I fear, resort to 
the public-house merely to quench thirst. Fountains, 
the gift frequently of the philanthropic, are springing 
up in all our large towns, and these might beneficially 
be still more increased. Were the Chinese innocuous 
draught to be supplied cheaply, or even in some cases gra- 
tuitously to the poor, for example, the necessity of assuaging 
thirst by being driven to strong drink would be saved. No 
man is deprived by our laws of the means of his lawful gra- 
tification, but certainly great advantages would result from 
the Chinese plan. I am obliged to confess that I cannot 
see the rationale of so much denunciation of tea drink- 
ing, usually merely a cup, by our profession, when taken 
as in the' kettledrum, or at any other time in the afternoon, 
or immediately before or after dinner. A thousandfold 
more evil has sprung, in my opinion, from the morning or 
afternoon's glass of wine, and the sherry cobbler, or sherry 
and bitters, or brandy, &c, so frequently had recourse to as 
a fillip just before dinner, and frequently so recommended. 

Speaking of beverages leads me to say a word about 
tobacco and opium. Tobacco, unknown in the last dynasty 
(1368-1644), or only to a very limited extent towards its 
close (the middle of the 17th century), is now nearly as 
universal as tea, and has spread with marvellous rapidity. 
It was a crime punishable with death, the same quaint 
reason urged by Sovereigns of Europe and Popes of Rome 
being urged by the Chinese Emperor, namely, that men 
appeared like devils emitting smoke from their mouth and 
nostrils. Now eighty percent, of the whole population of both 



32 

sexes, above twelve years of age or so, may be seen with the 
pipe. It is hardly every out of their mouths, especially among 
the women. The native tobacco is mild in the extreme, 
and probably few bad effects result from smoking it ; at any 
rate these are reduced to a minimum by the extensive use 
of the water pipe, which seems worthy of imitation by smokers, 
here for the coolness and comparative purity obtained. The 
water absorbs a large proportion of the nicotine and other 
deleterious properties of the weed. As smoked by our 
people, some of these constituents travel along the stem of 
the pipe into the smoker's mouth and sometimes down to 
his stomach. We hear complaints of dyspepsia, dryness of 
the mouth, sore throat, amaurosis sometimes, various ner- 
vous diseases, long retention of images on the retina after 
the objects have disappeared, affections of the ieart, irre- 
gularity in its action producing faintness, &c. Cigars are 
worse than pipes on account of the more ready and rapid 
absorption of the nicotine. Chewing, which seems almost 
expelled, at least from good society, is manifold worse 
than smoking ; snuff-taking is very common among both 
Mongols and Chinese; the snuff being usually highly 
flavoured with various odoriferous substances. I cannot 
say I have seen any bad effects from tobacco smoking among 
the Chinese. If our people will smoke — and I suppose it 
may be useful in some cases in preventing the bad effects 
of over-action and extra excitement of the heart — I would 
at least advise them to use long clean clay pipes, to abjure 
the black cutty or blackened meerschaum which have lost 
all their absorbent power. 

I am sorry I cannot speak in the same terms of opium, 
of all our luxuries the surest destroyer of health, property, 
position, and life ; of all our vices the most insidious and 
most difficult to throw off; one of the quietest and least 
obtrusive, yet that which beyond all others tells most seri- 
ously in the long run on national life and prosperity. This 
is hardly the place to enter a protest against opium con- 
sumption, but in considering health and disease among the 
Chinese, it is impossible to shut out this factor. Whole 



33 

chapters, if not volumes, might be profitably taken up with 
the consideration of this subject in all its various aspects, 
but the medical is alone of interest to us at present. The 
effects of opium accord well with the Chinaman's natural 
temperament, which leads to patience and love of peace, 
rather than rude blows and fighting. There is no just com- 
parison between the man who indulges in excess of wine 
and the one who takes a pipe of opium ; the latter is more 
like the habitual dram drinker, whose depraved and vitiated 
appetite now craves for the powerful stimulant. Opium is 
preferable to spirits, for it does not brutalise ; it does not 
excite the fierce passions of men, but by enervating, soothes 
them. The habit is easily acquired ; a fortnight's regular use, 
and it will require an almost super-human effort to cast it off. 
This is one of its most characteristic peculiarities. The 
gnawing agony of the unsatisfied craving is maddening ; 
physical strength is prostrated ; the mind weakened, and a 
few seconds after the opium pipe has touched his lips, the 
smoker is relieved for the time being of all his suffering. 
He anticipates his craving and flies to the stimulant ; if 
deprived beyond the usual period he gapes, yawns, and 
discharges mucus from his eyes and nose, and is perfectly 
miserable and good-for-nothing. There are rare cases of 
great determination throwing off the evil habit; body 
and mind are usually too weak for the execution of the pur- 
pose. The curse of the habit, like drunkenness, falls with 
special severity upon the poor ; half of the labouring man's 
wages are spent on this single article. We can imagine the 
misery at home — his constitution ruined, family reduced to 
poverty, situation and character lost, beggary his inheri- 
tance, and thieving his portion. He brings a variety of 
physical evils upon himself, dyspepsia, inveterate constipa- 
tion, dysentery and diarrhoea of an intractable character 
threatening the life of the confirmed smoker who would 
renounce the vice, and too frequently it is so without the 
renunciation of the pipe ; spermatorrhoea follows with its 
long train of evils affecting his posterity and the popula- 
tion of the country. I cannot take time to pourtray all the 



34 

physical evils which we find following in the wake of the 
smoker. The good he derives in chest affections, such as 
cough, chronic bronchitis, ordinary diarrhoea and dysentery, 
when not caused by the drug itself, are for a time at least 
substantial gains, although I fear it renders the radical cure 
of many of these affections in the long run more difficult, 
in reducing vitality and the resistance of the body to dete- 
riorating influences. This part of the subject might form a 
paper itself. Fortunately for China none of the other nar- 
cotics have as yet obtained a footing, such as chloral, 
chlorodyne, chloroform, ether, and absinthe, that regularly 
carry off so many victims in Europe, and are sapping the 
constitutions of large numbers of the very best of our 
people.* 

Food. — From drinks we pass naturally to consider next 
the food of the Chinese. Few countries produce such a 
variety of cheap and good foods as China, and fewer still 
that will bear comparison with her people in the art of 
cookery. Their food is of a mixed kind, although the vege- 
table diet from its cheapness prevails. The chief animal 
food eaten is pork, combined, as in the North bordering on 
the grass lands of Mongolia, with mutton. Pigs and ducks 
are their favourites, because easily reared, and the flesh is 
more savoury and contains much fat. Earth worms and 
snails, rats, kittens and puppies, though frequent in the 
pages of travellers, are fortunately rare in Chinese markets 
and on Chinese cookstalls. The cow or ox being regarded 
as semi-sacred (because used in sacrifice to the Supreme 
Being at the Temple of Heaven, and also used in agricul- 
ture), comparatively little beef is eaten. In seasons of 
drought edicts are issued against the slaughtering of bul- 
locks. If the filthy habits of the pigs in China induced 
trichinae, the most disastrous results would ensue, for pig life 
there is simply revolting. Rice, or rice and sweet potatoes, 
flavoured with pickled vegetables or salt fish, is the staple 

* See paper by the writer, read at the Social Science Association at 
Liverpool, Sept. 1876, on "Some of the Physiological Actions of Opium in 
Relation to Health." r 



35 

food at Amoy. At Newchwang, in the far north, it is prin- 
cipally boiled millet, a simple, cheap, and nourishing article 
of diet, possessing all the essential elements of nutrition, 
occasionally partaken with vegetables. Six people can live 
well upon this fare for four dollars monthly. Dr Watson 
there says, all who can afford it drink a little coarse spirit, 
but so sparingly that it is rare to find a drunk person. It is 
much the same all over China — rice predominating chiefly 
in the south — and rice, alternated with flour or millet, among 
the better classes in the north. These are combined with 
oils, fresh and salted vegetables which supply in abundance 
all the elements for healthy nutrition. It is remarkable 
they should have hit naturally upon such a diet ; the legu- 
minous seeds supplying the nitrogenous matter, and animal 
and vegetable fats remedying the want of fat in the rice. This 
diet therefore seems to give them the four essentials for the 
proper maintenance of the body. Of course there are vast 
multitudes to whom rice would be a great luxury, and whose 
diet consists of little more than sweet potatoes and salted 
vegetables. 

The Chinese partake usually of two meals, one early in 
the forenoon and one late in the afternoon. Late heavy 
dinners and suppers, with copious vinous potations, are 
utterly unknown. The hour for dinner parties is usually 
two or three o'clock in the afternoon, sometimes earlier. 
Dyspepsia is one of their most common maladies. The 
vegetable food is bulky, and the quantity of raw and unripe 
fruit and vegetables which they consume, combined with so 
much hot water and tea, confections, pastry, &c, are well 
calculated to produce dyspepsia. This indigestion exists 
chiefly in the form of flatulence, with some disturbance 
necessarily to the heart. They usually style the various 
forms as a blocking up of the entrance to the stomach; 
cardialgia, or more frequently by " liver air." Dyspepsia 
seems far too common among so poor and abstemious a 
people. One facetious writer has called it " The remorse of 
a guilty stomach." One of these Chinese dyspeptics com- 
plained once to one of our brethren, saying that she could 



36 

eat nothing, and was subject constantly to pain, and he 
found that she had just eaten three or four hard boiled eggs 
— then had taken some Chinese medicine — then several 
potions of hot water, and at that very moment was steep- 
ing the red wood of her rouge powder box for a final 
draught! 

Foreigners in China, and the same holds good of Euro- 
peans at home, err on the side of eating and drinking too 
much. It is remarkable that every animal but man keeps to 
one dish, and some one has said that as many dig the grave 
with their teeth as with the tankard, and another that if 
the secret of rejuvenisation be ever discovered, it will be 
found in the kitchen. I should be far from advocating a too 
meagre diet, especially in the climate in which we live in 
China. By experience, in winter at all events, and in the 
north, we find our wants are even greater than in England. 
But there can be no doubt, I think, that the excessive use 
of animal food is one of our national weaknesses. It has 
assumed an importance which it does not deserve. It is 
with some the main article at all meals. All the conditions 
of a good nutritious diet may be found in what is much 
cheaper. Need I instance good porridge and milk in our 
own country. The old Roman gladiator's chief food was 
barley cakes and oil. Our modern meals have ceased to indi- 
cate what is doubtless the origin of the word. Full animal 
diet three times daily combined with various liquors, must 
induce many diseases, and predispose if not excite to inflam- 
matory attacks, from all of which the abstemious Asiatic is 
free. If this kind of diet be combined with want of exer- 
cise, and the persons living in rather a high temperature, 
as is the case with many of our Europeans at the open ports 
in China, I fear it is but natural we should look for some of 
the maladies already mentioned. I have read of the defini- 
tion of an Englishman in India, as an individual who eats 
beef, drinks brandy, and has no religion ; or as a witty Irish 
medical man, a friend of my own, once put it — " Europeans 
come to China, and they eat, and they drink, and they drink, 
and they eat, and then they die, and afterwards write home 



37 

that the climate killed them!" The temperate in eating 
and drinking, and who exercise discretion in exposing them- 
selves to the sun's rays in tropical countries, keep their 
health as well there as at home. The following are a few 
of the Chinese precepts in dietetics: Do not offend in 
quantity — breakfast early — make a hearty meal about noon 
— eat slowly and masticate thoroughly — do not gratify the 
appetite so as to rise from the table quite satiated — sup 
betimes and sparingly — let the food be tender and well- 
dressed — do not sleep till two hours after taking food, and 
begin meals by taking a little tea. It is recommended to 
avoid smelling musk and young orange blossoms, which 
contain imperceptible insects, for fear of such vermin finding 
a way up to the brain. The air is full of imperceptible 
germs of various small insects which we suck into the 
stomach with our breath, but they cannot be hatched there 
for want of a fit medium, whereas the insects which lay 
their little ova in the mealy cup of flowers, may be drawn 
up by the nose with a ferment proper to hatch them. Food, 
moreover, should be taken a little warm, with the view of 
keeping up the internal warmth, for the radical moisture is 
apt to be weakened and evaporate in water and sweat. In 
summer, especially, are the spirits much spent and the kid- 
neys weakened. This is a quotation from a book on the Art 
of procuring Health and Long Life, published in 1697; 
translated by one of the Jesuits ; to be found in Du Halde II., 
p. 236, and as you will observe broaching the germ theory. 

Clothing. — A few remarks on clothing come next for con- 
sideration. In the material of her fabrics and the shape of 
her clothes, for both sexes and all ages, China will not suffer 
in comparison with other nations. In some respects she 
has the decided superiority ; her clothes are well adapted 
for the climate and the character of the people. The dress, 
which is of the most becoming and simple kind, can be 
adapted with remarkable ease to quickly altered atmospheric 
conditions, and in this respect they teach us a useful lesson 
in exercising great carefulness in adapting our clothing to 
sudden changes of temperature. The sameness of our 



38 

clothing appears very ridiculous to them. The Chinaman's 
material is changed with the changing season, but the 
fashion never changes. All Oriental countries are similar 
in this respect. In winter to strip a Chinese of his clothes 
might be compared to skinning an onion — the layers 
are so numerous, and yet his dress remains the same. 
Without changing the entire suit, he takes off or puts 
on as occasion requires. In the spring and autumn 
this is particularly necessary. The morning and even- 
ing dress is hardly suited for midday, and vice versa. 
The black-haired race is destitute of shirts, flannels, and 
anti-cholera belts. Their style of dress, coupled with their 
style of living, renders some of these foreign requisites 
unnecessary. Our abdomens are not half so well protected 
from sudden cold, &c, as those of the Chinese. Diarrhoea, 
dysentery, colic, &c, are frequently prevented in summer 
among our Europeans, especially new-comers, by the adop- 
tion of such belts or bandages. How much mischief is 
created by our failure to clothe ourselves seasonally ? A good 
old rule was, not to lay aside winter garments before a warm 
May, and to put them on before a cold November. Our 
people certainly err greatly in leaving off winter clothes 
too early, and not putting them on early enough in autumn. 
Adjusting dress, according to the vicissitudes of the weather 
here, in this ever-varying climate, where often "in one 
monstrous day all seasons mix," is, though difficult, a matter 
to be carefully attended to if we are to enjoy good health. 
One has said that " if we are careful, glass will last as long 
as iron," and Boerhaave has remarked that " only fools and 
beggars suffer from cold ; the latter not being able to pro- 
cure sufficient clothes — the former not having the sense to 
wear them." Our dress is rendered utterly unsuitable if 
almost any part of it be touched. We cannot accommodate 
it to the varying changes of a variable climate like ours 
without destroying its harmony in most cases. I need not 
refer particularly to our errors of dress, some of which have 
been held up to ridicule,. and deservedly so by the Chinese, 
such as tight lacing, tight and stiff collars, neckties, sleeves 



39 

and vests, cravats, tight and hard boots, high heels, the long 
trailing dresses of the gentler sex, the low necked dresses 
and short sleeves, or rather no sleeves of evening parties ; 
a practice, let me add, which cannot be supported by one 
single argument, and which, coupled with heated rooms, 
iced drinks, hot beverages, chilly lobbies and halls, and all 
in our winter weather, is most absurd and is certainly the 
fruitful cause, sooner or later, of much bronchial and pul- 
monary mischief. There is also exposure of the chest in 
men — insufficient protection of the abdomen where waist- 
coat and trousers meet — the dark clothes worn in summer— 
the crape and black mourning so generally and so long worn 
in the light of devotion to the departed — bad ventilation 
through waterproofs, galoshes, and many other points ; not 
to speak of the more than questionable good taste displayed 
in short jackets, cut-away coats and tight fitting trousers. 
The Chinaman's long robes, which are the rule, button close 
up to the neck, and stretch down almost to the feet, and 
envelope the whole body. A painting or sculpture, which 
exposed anything but the head and perhaps the hands, 
would be set down as barbarous and gross. In summer, a 
long cotton or silk robe is the chief part of the dress ; in 
winter, cotton-wadded garments among the middle and 
lower classes, and the various furs among the higher classes 
prevail. Nothing could be more neat and tasteful than the 
ladies' dresses in China, whether of the higher or lower 
classes. Crinoline and chignons have always been a mystery 
to them. In our campaigns in hot climates, the thick coat 
and heavy hat, or small forage cap, have destroyed by 
sunstroke and apoplexy, more lives than the enemy's swords 
or bullets. Chinese tailors, let me say, sit at their boards, 
and so are saved from those troubles to which the sons of 
the needle with us are exposed from their stooping and 
cramped position. And as to their shoes, the top and sides 
are made of calico, silk, satin, or velvet, and the soles of 
several layers of thick paper, rags or felt, protected some- 
times by a thin outer sole of leather. They are soft and 
easy to the feet, and these plagues of over-civilisation, corns 



and bunions, are almost unknown. The winter shoe is 
padded with cotton. The Chinese can dispense with boards 
in their houses, as from the thickness of the sole, one or 
sometimes two inches, they may be.said to carry their floor- 
ing constantly with them; it raises them above the dirt, 
damp and wet. These thick soles suit their dignified gait, 
and the only evil which I have found from their use, is the 
necessity for constant paring of the toe nails — a regular 
craft of chiropodists existing in all Chinese towns for this 
purpose. It can be readily understood that ingrowing nail 
and. the evils of overparing frequently present themselves. 
Chinese police in the winter are supplied with large' sheep- 
skin coats which keep out the cold thoroughly. In regard 
to head-dress, in summer they wear generally white straw 
hats, which permit a current of air to pass freely round the 
head, or they have besides large rims which hang down 
and shade the face, neck and shoulders. In winter, they 
wear a cap of silk or satin, or a warm soft one of felt. Many 
expose their heads to the most violent sunshine without the 
slightest danger, or protect themselves with only a hand- 
kerchief or fan, but such have been born and brought up in 
the country. Sunstroke, or heat apoplexy, are unknown at 
Pekin. No cases of these affections have occurred among 
foreigners, and we have missionaries of the Protestant, 
Roman Catholic, and Greek Church, some of whom having 
adopted the Chinese dress, go about as the Chinese do with 
impunity without any head covering. 

In the precepts laid down in the native work already 
referred to for regulating the actions of the day, it is said, 
"wind is to the air what anger is to the passions, therefore 
avoid air coming through narrow passages." The proverb 
is — avoid a blast of wind as carefully as the point of an 
arrow — during perspiration do not leave off clothes, or ex- 
pose yourself to fresh air, and the abdomen, even in sum- 
mer, is to be protected. Change linen frequently, but do 
not put on clothing that has just been dried in the sun. 
Clothes stowed away in boxes with camphor are always 
freely aired before being put on, because of the anaphro- 



41 

disiac effect of that substance. The Chinese dress, as a 
whole, is invulnerable. Can this be said of ours ? 

Disposal of the Dead. — Let me add a word as to the 
Chinese disposal of the dead. China has no public cemeteries 
in our sense, if we except, perhaps, such as those of the 
Eunuchs, of the Emperors of a dynasty, and of the official 
ground set apart for the interment, at the imperial expense, 
of children deposited at the mortuaries outside the city 
gates for the poorest of the people who own no land, and 
for those who die away from home without relatives. 
All interments are made in private ground, and none is 
allowed within the walls prop erj of cities. It is interesting to 
note this fact in Chinese civilisation. In respect to this 
subject we have the testimony of Philologus of Ravenna, 
the first physician in the west, perhaps, who censures the 
pernicious custom of having public burying places in popu- 
lous cities, " which -taint the atmosphere with cadaverous 
streams and frequently occasion fatal distempers. I am 
astonished " he says, " that the moderns should approve of 
a practice which the wisest nations of antiquity prohibited 
by the most solemn laws." Well-to-do families in cities, 
possess private burying grounds outside, and these are gene- 
Tally covered with grass and planted with firs, cypresses and ' 
willows. There is no crowding of the dead. In the country, 
among the agricultural classes, every one seems to possess 
a bit of land, the dead are buried frequently in the culti- 
vated fields of the family. The mounds, although religiously 
tended, disappear in the course of time under the influence 
of tillage, the weather and the encroachment upon them 
year by year, of the crops. China, in this way, may be said 
to be one vast cemetery, the whole aspect of the country is 
so studded with mounds. That we do not live entirely 
among the tombs is owing to their gradual disappearance 
from the face of the soil. There is one practice, however, 
which must be condemned, and that is the habit among the 
better classes of keeping the dead for weeks, months, and 
sometimes years and generations, from motives of respect- 
ability, feelings of affection, or temporary inability to inter 



42 

with becoming decency, suitable to their position and rank. 
In seasons of epidemics, such as cholera, smallpox, or diph- 
theria, this practice is most dangerous. After death, diviners 
and priests are called in, and a protracted chanting of prayers, 
weeping, howling, singing, burning of incense, a beating of 
gongs, bells and drums, is kept up, and I have seen the 
most disastrous consequences follow this custom. There is 
this' to be said, on the other hand, that the coffins are of 
substantial wood, very thick, and are well covered with 
cement, so that they are in most cases air tight. Cre- 
mation is sometimes had recourse to in the case of 
Buddhist priests of note. European towns suffer from 
the contaminated ah - over or near cemeteries. The trees, 
plants, grass and crops which obtain in China in or around 
their burying places, must be very useful in the absorption 
of deleterious substances. 

Exercises and Trades. — Such is the state of civilisation in 
China, that it may be said there are no particular trades 
specially injurious to life. Their shops, places of business, 
and such few industries and manufactories as they have, are 
all carried on out of doors, or in the free open air. As a 
rule, they rarely have recourse to exercise, in our sense of 
the word. Among the Manchus, archery is compulsory, and 
occasionally among the soldiers, we see them practising 
fencing, wrestling, throwing the stone, &c. The Chinese 
and Manchus alike are greatly given to shuttlecock, at 
which they are most expert, and a great deal of time and 
pains are bestowed upon bird catching, training, airing, 
teaching to sing, carrying in cages or on sticks, pigeon 
flying, and above all, kite flying, pastimes in which adults 
play the principal part. A most elaborate system of medi- 
cal gymnastics obtains in China, called kung-fu, which is 
both preventive and curative of disease. We find this 
system principally practised by the Tauist priests, who 
were the first alchemists in the world. For centuries they 
have been in search of the philosopher's stone. They have 
practised healing by magic, charms, friction, &c, and many 
books have been written on the art of procuring health and 



43 

long life. In ancient times, curing by pressure and friction 
formed one of the thirteen departments of the great Medi- 
cal College. A most interesting article might be written 
on this subject alone. The Chinese thus first gave the idea 
of the Movement Cure, which is now practised in most Euro- 
pean countries, founded on the anatomical basis of the 
Swedish physician Ling. The system was first brought to 
European notice last century, through an article by one of 
the Jesuits in their memoires. At the present day curative 
and prophylactic gymnastics are to a large extent in the 
hands of the barbers. Besides shaving the head, which, by 
the by, is done without the use of soap, hot water being 
only used — and plaiting the queue, they clean the eyes, 
ears, and nostrils of their customers ; they put the eyebrows 
in order, and perform generally what is known in Europe as 
macer or massage. By extending the limbs, and gently 
rubbing them with the palm of the hand, the circulation is 
promoted, and tone and suppleness is given to the muscles. 
The operation generally consists of tapping, kneading, 
pinching, chafing, and pommelling the body all over, pro- 
ducing the most delightful sensations and proving very 
bracing. I have known adults put to bed every night by 
their attendants so operating upon them. 

Epidemics. — A word as to epidemics. And first small-pox. 
This disease is endemic; it is never absent, although in 
certain years and certain seasons it is much more virulent. 
It prevails most generally in winter, and unfortunately this 
is just the season, from superstitious ignorant notions, when 
the Chinese will not vaccinate. Children only in China take 
small-pox, but then all take it, with very few exceptions. 
The Chinese laugh at the idea of foreign adults contracting 
this disease. The poison is supposed to be communicated 
from the parents to the foetus; all therefore possess the 
small-pox germ in their constitutions, and only waiting for 
development — often compared to a flint which requires but 
to be struck to emit fire. The disease is very fatal. At 
Canton, in one epidemic, or rather a more than usually 
virulent endemic attack, 20 to 30 per cent, of the unvacci- 



44 

nated died ; at another time, as many as from 40 to 50 per 
cent. The mortality was very inconsiderable among the 
vaccinated. There are some fifty or sixty professional 
vaccinators in Canton. About half of the children get pro- 
tected in this way. The Chinese have taken wonderfully 
to vaccinalpon, and it is productive of the best results. 
They have made its practice coincide with their own 
theories, and although there is thus an air of mystery thrown 
around it, the success of the operation is. not invalidated. 
They are most particular in regard to the lymph, the con- 
dition of the child, the season of the year, &c, and their 
great care is rewarded with great success. The whole sub- 
ject is full of interest, and useful lessons might even here 
be learned by us, but space forbids our entering upon it. 
Their rule is to vaccinate in three distinct places in each 
arm, and the operation may be termed the hypodermic one. 
It was introduced into China in 1805. In this country we 
can hardly now realise the blessings of Jenner's discov^py. 
This disease has been known in China since about the end 
of the 9th century of our era, and therefore much about the 
same time as in Europe. Inoculation in China has been 
known and practised since the Sung dynasty (A.D. 960— 
1127). 

Diphtheria existed as an epidemic at Peking in 1866, 
and is more or less always present, and proves very fatal. 
I have known of twenty-four deaths in a family of twfenty- 
six individuals within one month. I have not heard of it 
elsewhere in China. Our brethren at the ports all note its 
absence. Its origin goes back to 1821, and is attributed to 
the import of lucifer matches. 

There was an epidemic of Jaundice at Peking in the 
autumn of 1861, and no fewer than 370 applied at the hos- 
pital for relief. This epidemic was not owing to any 
particular article of diet, but to sudden changes of tem- 
perature. 

Cholera visited China in 1862 and 1863, and was pretty 
general all over the country. Since that time no epidemics 
have been witnessed. In 1863, at Canton, from 700 to 1200 



4b 

died daily for three weeks, and on the 14th July the deaths 
reached 1500 in twenty-four hours. About 15,000 or 20,000 
in the two months in the autumn of 1862 were carried off at 
Peking, and probably as many at Tientsin. It followed the 
course of the river, attacking the various towns on the, 
banks, and lastly reached the capital. A severe epidemic 
occurred in China in 1820-23. At Ningpo, 10,000 were then 
carried off. It prevailed at Amoy in 1842. It has been 
known in China, as in India, from time immemorial. It was 
described 2500 B.C. by the very name which it now bears, 
viz., hwo-luan, an expression meaning something huddled up 
in a confused manner inside the body, which is evidenced 
by the vomiting and purging. No doubt the term is also 
applied to what we designate as English cholera. The 
Chinese reckon two forms of this disease, the wet and dry, 
according as there is the presence or absence of vomiting 
and purging. The latter or dry, is considered the most fatal 
form. 

It only remains now to note a few remarks on> some 
of the other more frequent diseases in China, not 
already referred to, and first in importance comes phthisis. 
Diseases of the chest are, on the whole, remarkably rare in 
China. We have already referred to their immunity from 
heart diseases. Other diseases of the chest, such as pleurisy, 
pneumonia, acute bronchitis, are hardly known, and phthisis 
is far from being so common as in this country. The author 
of the Middle Kingdom, the oldest resident in .China, re- 
marks thus : — " Diseases of the viscera, of an acute inflam- 
matory nature, are not so fatal or rapid, nor does consump- 
tion carry off so many as in the United States." At Canton, 
in the south, Dr Wang says, " phthisis is tolerably prevalent, 
but by no means so common as in Europe and America." 
Dr Kerr, many years a missionary practitioner there, con- 
firms this opinion. "It is difficult," Dr Wang says, "to say 
why it should be so, as the causes which produce consump- 
tion, such as bad air, insufficient food and exercise, bad 
hygiene, &c, must be much more operative, and must exist 
to a much greater extent here than in the more civilised 



46 

countries of Europe and America." One thing ought to be 
mentioned, he says, in connection -with this question (if 
pneumonia and bronchitis have anything to do with the 
genesis of phthisis), that the Chinese here are not liable to 
acute affections of the chest. At an earlier period he 
writes that he saw only one case of acute bronchitis — the 
only case of acute affection of the lungs in three years. 
Idiopathic pleurisy and pneumonia he had never seen; 
and haemoptysis in men and especially women is by no 
means such a sure sign and precursor of phthisis as it 
is in Europe. Chronic bronchitis is common, and so also, 
to a certain extent, is asthma. I can endorse most fully 
and heartily every word of this — it is an exact descrip- 
tion of our pulmonary practice at the capital. Dr Wang 
further adds, and I now quote his very words : — " The rarity 
of consumption among country people, and the greater, 
exemption from it of the labouring class in the city, not- 
withstanding that they are badly housed, and badly fed, 
must be attributed to exercise and life in the open air, and 
I am inclined to think, that their food, though poor in 
quality, is not, as a rule, insufficient in quantity. Still I 
cannot quite understand why phthisis is not more prevalent 
than it is among them, especially the country poor, whose 
food often seems not more than sufficient to support life. 
Scrofula, another form of the disease" — and here I agree 
with him too — " is often seen in the hospital. The whole 
subject," he adds, " deserves investigation." 

Chest affections at Shanghai are not generally severe, 
and the cases seen are mostly imported. In Formosa, 
phthisis is common, but of a very chronic nature. Acute 
disease of the respiratory organs is extremely rare at Amoy; 
pneumonia and severe bronchitis are almost unknown among 
resident Europeans there. Dr Smith, at Hankow, reports : 
" The natives spit blood with little or no provocation at all, 
and with but very little evil consequences ; consumption is 
comparatively infrequent," and he suggests " that it may 
be owing to the great frequency of chronic bronchitis." 
Dr Reid, also of Hankow, is rather inclined to combat this 



47 

view, when he considers the great prevalence around him, 
and in China generally, of the usually recognised causes of 
the disease. It is certainly staggering to one not thoroughly 
acquainted with the Chinese constitution, and even then, 
one is very apt to make one's practice almost unwittingly 
square with our theories and preconceived notions. After 
commenting on the various causes that exist predisposing and 
exciting to the disease, such as we have already enumerated, 
in the great want of sanitary science, he- adds — " if con- 
sumption did not follow as a consequence of all this, we 
should have a result different from what has been observed 
in other parts of the world, where like predisposing con- 
ditions are found." But unfortunately for his argument, we 
have it frequently in this country> .where few, if any, of the 
causes emunerated at Hankow obtain. His causes, I may 
as well state, are these — that more than half the town 
population are debarred from exercise, and rarely, if ever, 
inhale fresh air ; that the country people chiefly live on a 
vegetable diet, and often partake of it in insufficient quantity 
for the purpose of nutrition ; that the subsoil in many places, 
and at certain seasons, is saturated with moisture ; that the 
general health is deteriorated by the action of malaria, and 
lastly, on the strength of his colleague, Mr Porter Smith, 
that haemoptysis is acknowledged to be a common occur- 
rence. He further adds, — " supposing phthisis to be rare, 
its rarity cannot be ascribed to the absence of a special 
tubercular diathesis among the Chinese, since the researches 
of G-erman pathologists have demonstrated that this disease, 
in the vast majority of cases, is, at its outset, a cheesy dege- 
neration of inflammatory products, and that this may super- 
vene on any inflammation of the lungs, although most 
frequently following chronic catarrhal pneumonia ; and fur- 
ther, that tubercle is a secondary result, produced by the 
action of cheesy morbid products on the organism. This 
tendency to cell hyperplasia and cheesy degeneration is 
fostered by causes which deteriorate the health, whether 
acting from without or from within the body, and both 
classes are frequent enough in. China." It is no doubt 



48 

frequent — Dr Reid saw 118 cases out of over 5200; but even 
on his own showing and enumeration of causes, I think 
Dr Reid would agree with me, that it is after all not so pre- 
valent as we should have expected, and certainly not so 
common as in this country where, as already remarked, the 
same causes are neither so numerous nor so severe. The 
Chinese hardly know what acute inflammation means, and 
all admit that even phthisis is very chronic. I have also 
seen many cases of hasmoptysis that have not been speedily 
followed by its ordinary consequences. No doubt such 
patients may, and do eventually succumb, but it is very 
chronic. Bronchial catarrh is exceedingly common every- 
where in China, and of course particularly in the northern 
half of the country, and especially during the long and 
severe winter. This affection becoming chronic, which is 
the normal condition, simulates phthisis, and this may ex- 
plain, perhaps, the frequency of this affection noted at Han- 
kow ; although we are told special care was exercised in each 
case to guard against a wrong diagnosis. Speaking of the 
naval forces in Chinese waters during and after the first 
opium war, Dr Wilson says — " We had only one undoubted 
case of phthisis, and that in an officer whose case had 
clearly originated in England." Bronchitis, he tells us, 
though not common, occurred more frequently, but was 
seldom met with as an original disease having much power 
and apart from common catarrh ; and when it has given 
rise to pulmonary abscess, without doubt being confounded 
with phthisis. One thing, he says, is certain, that idiopathic 
affections of the lung are not common at Hong-Kong, and 
tubercular phthisis originating here has hitherto been all 
but unknown, if ever witnessed, at least in the naval force. 
This exemption, he adds, is in conformity with what has 
been noted in other miasmatous districts — where there is the 
prevalence of ague, consumption is not rife. 

Dr Reid lays considerable stress upon the proved con- 
nection between phthisis and abundance of soil-moisture 
and drainage, and quotes one authority to prove that the 
death rate of phthisis, in certain English towns, depends upon 



49 

the efficiency of the drainage, and Mr Simon declares, that 
" dampness of soil is an important cause of phthisis to the 
population living on the soil." On this ground, if on no 
other, Hankow, ■ and many other places in China, ought to 
be hot-beds of the disease. If, then, as Dr Reid himself 
asks, the disease be rarely met with in China, will it show 
that certain elements now supposed to be powerful agents 
in rendering phthisis prevalent among a population, have 
been over-estimated as regards their evil influence on the 
body, or that some other conditions exist which modify or 
neutralise them ? 

A certain antagonism has been supposed by some French 
surgeons in Algeria and some American writers, to exist 
between ague and phthisis. Where the one prevails the 
other is either absent or very rare ; and certainly the obser- 
vations made in China would seem to bear out this doctrine, 
Ague is very prevalent in the centre of China along the 
course of the great river Yangtse, which is, Nile-like, subject 
to periodical risings and overflowings. It is also very com- 
mon in the south, most probably the most frequently met 
with disease there. At Peking, the soil being sandy and ab- 
sorbent, and there being little damp or marshy ground, ague 
in ordinary years is one of the rarest affections. The heat 
there is extreme for six weeks in summer, and the rain- 
fall is copious at that time. The streets of the city and parts 
of the surrounding country are frequently for days and weeks 
under water. During the great inundations of 1870 and 
following years in Chihli, ague rose to the first place in point 
of numbers. In Shanghai, from April, 1860, to July, 1861, 
28,000 cases were seen ; ten were for pulmonary consumption 
(seven were well marked), and 1400 were for ague. Tubercle 
is common, but is confined entirely to the abdominal organs. 
My experience at the capital all points towards the same 
conclusion. In Formosa, one practitioner disputes this sup- 
posed antagonism, and notes forty-seven cases of phthisis in 
twelve months, and 718 cases of malarial disease. During 
the summer of 1872, he notes again 340 cases of intermittent 
fever, and 38 cases of chronic phthisis. At another part of 



50 

the same island, during the same time, 20 cases of consump- 
tion were observed. It might, however, be a question, if 
malaria do not entirely neutralise it, does it not modify it ? 
If so, this might account for the prevalence of the one, and 
comparative infrequency of the other. Or is this great im- 
munity from consumption (for such we must all admit) where 
ague is rife, to be accounted for on other grounds, such, for 
example, as that of heat alone, predisposing, according to a 
well-known and fully-recognised division of diseases, into 
abdominal and thoracic, the former predominating in the 
southern and hot, and the latter in the northern and colder 
regions % 

Time forbids my entering on a detailed statement of the 
other diseases generally met with in China. Suffice it to 
sum them all up very briefly. Leprosy, both tubercular 
and anaesthetic, is common in the centre and south of China, 
and it has been known from the most ancient times. A few 
cases have been observed of both forms in the north. Lazar 
houses exist — it is not considered contagious. It is looked 
upon as incurable, and is attributed to the exhalations aris- 
ing from low damp ground. — Lymph scrotum and elephan- 
tiasis are also found abundantly in the south. — There is a 
good deal of anaesthesia in the north of China proper, not 
connected with leprosy. The people, and particularly the 
Mongols, suffer greatly from rheumatism, caused to a large 
extent by the practice of sleeping on the ground in tents as 
the nomadic hordes do, and under the eaves of the houses 
or verandahs, or in the cold kangs, as in China. The tem- 
porary loss of sensation in such cases is, doubtless, attribut- 
able to causes similar to those operating in the causation of 
neuralgia and rheumatism. Diaphoretics are found peculiarly 
useful. Dr Wilson remarks that malarious districts have 
seemed to dispose, if not excite, to attacks of rheumatism, 
but this he did not find to be the case at Hong-Kong ; and, 
therefore, he asks if the neuralgic affections have not been 
set down as rheumatic % The former, he says, are not un- 
common in malarious positions where the more open and 
injurious effects of the poison are very rarely manifested. I 



51 

may here notice that cases of acute rheumatism have not 
been observed. — Whooping cough is not known as a distinct 
disease by the Chinese, although their medical works describe 
such a disease. It is classed with ordinary cough, and its 
infectious character is not dreamt of. It is not a prevalent 
affection. — Scarlet fever is also barely recognised. When it 
does exist it is usually classed with measles. The latter dis- 
ease is invariably mild, and I never heard of a fatal case. It 
may be a question how far small-pox, which is universally 
prevalent and endemic, has modified or altogether done away 
with such infantile diseases, so common and fatal in this 
country. The Chinese sleep on cotton wadded mattresses, 
so that Dr Salisbury's theory of mildewed straw beds as 
causing measles does not obtain in China. — The absence of 
typhoid has been remarked as something very peculiar in 
view of the physical conditions everywhere existing, and of 
the habits of the people. Milk has been shown in this country 
to be a fruitful source of typhoid fever ; but in China milk 
forms no part of the diet of the people, and here again we 
have one important factor less in the causation of disease. 
Scrofula is often seen in China, as evidenced in suppuration 
of glands, hip-joint disease, and also in spinal curvature, but 
not so frequently as in our large towns in this country. 
These affections are found most commonly among women, 
who, owing to their small feet and the retirement to which 
custom condemns them, are deprived Of exercise and exposure 
to fresh air, two things which are absolutely essential to 
health, and whose absence is the principal cause of the stru- 
mous constitution, and much of the phthisis at home with us. 
With regard to the small feet, it is remarkable that few direct 
evil consequences, such as necrosis of the bones, or ulcera- 
tion, etc., result from this barbarous mode of binding these 
members ; but the indirect results are very great, as witnessed 
in the strumous constitutions, the anaemia and its long train 
of dependent diseases, such as amenorrhoea and other uterine 
disorders. Such diseases, peculiar to the sex, are, I suppose, 
more prevalent throughout China than in any other country, 
and nowhere is the desire for children — sons at any rate— so. 



great. Anaemia is the fruitful source of much of the disease 
iu China, and has been by some considered the characteristic 
and important pathological feature of the Chinese constitu- 
tion. This condition is caused, in addition to the reasons 
already advanced, by ague, deficient and improper food, 
dyspepsia, itself the effect as well as the cause sometimes of 
this condition, andby toolong continued suckling of their chil- 
dren. — Boils and carbuncles are very common — one man 
is reported as having had as many as 200 during one season. 
Toothache is not very common — supposed, as already said, to 
be caused by worms — the population at large has very sound 
teeth, accounted for by their simple dietary. Shock is 
unknown. No patients, anywhere, bear operations with 
more fortitude, and owing to their lymphatic temperament,- 
they are followed with less inflammation than usual in Euro- 
pean practice. Time fails to quote case after case illustrating 
this point, and also the recuperative power of the Chinese 
system — recovering from the most fearful accidents, wounds, 
injuries, burns, operations, &c, with great ease and rapidity. 
Many cases that would be adjudged here as hopeless, or as 
incurable without surgical interference, get well there. 
Men, to all appearance mortally wounded, have recovered, 
making one almost doubt whether there really is such a 
thing as a'wound necessarily fatal ; men with the small intes- 
tines basking in the sun for hours or days, and covered over 
with dirt ; extraction of calculi filling up the whole bladder, 
and which, by all the rules of surgery, ought to have ended 
fatally ; three musket balls extracted from one individual, 
two of them having passed through the left lung, etc. The 
way in which operations are borne is perfectly astonishing. 
Where chloroform has been administered it has attracted 
universal admiration, and the accounts circulated of this 
wonderful medicine have not been less wonderful — the ex- 
traordinary " sleeping medicine," by which^a person could be 
rendered dead and afterwards brought to life. This has, in- 
deed, excited their surprise and attention, and it is declared 
twelve parts wonderful — ten being the natural number. The 
Chinese require a large amount to render them unconscious, 



53 

and their insensibility occurs without almost any preliminary 
excitement. Without chloroform they neither cry nor wince, 
and this is not to be accounted for, as is often done, so much 
by a less acute nervous system, but rather to moral .training. 
Their religiotis systems teach indifference to bodily suffer- 
ing or to life itself. I have hardly ever met a case in man 
or woman where objection was offered to taking medicine, 
or submitting to an operation, provided the latter did not 
necessitate parting with a member. The idea of the 
sacredness of the body and the necessity of keeping it 
entire — dismemberment being considered a sin against one's 
parents from whom the body was received — -of course mili- 
tate against amputations, and render dissection at present 
impossible. We have just said that operations are followed 
' with less inflammation than usual in European practice. 
The Chinese constitutions are essentially anti-phlogistic. 
Primary affections of internal organs are seldom encountered, 
and so strikingly is this the case all over the empire, that the 
order of phlegmasia of Cullen, forming in other places so large 
a portion of human maladies, might almost be struck out of 
the nosological catalogue without even an exception in fa vour 
- ofhepatitis. generally considered the peculiar and overwhelm- 
ing morbid product of the East. All inflammatory diseases, as 
remarked by Dr Wilson in 1858, in China and India, assume 
a far more passive than active form, and require less de- 
pletion than similar diseases in temperate climates. " The 
most sanguine physician," remarks another, " would never 
dream of bleeding a Chinese." Their diseases are chronic 
and adynamic. The Mohammedans and Mongols, who live 
largely upon mutton and meat, generally present more of the 
inflammatory type, and much more resemble Europeans in 
their diseases. — Skin diseases, especially scabies, psoriasis, 
lepra, eczema and pityriasis, are excessively common. — Nerv- 
ous diseases are remarkably infrequent, and supposed to be 
owing to the apathetic, peace and quietness-loving charac- 
ter of the people. The Chinese speak of the heart, seldom 
of the head, of which they know almost nothing.— Apoplexy 
among the aged officials, properly predisposed to it by their 



54 

obesity, and the necessity of performing the nine prostra- 
tions before the Emperor so frequently, is not very uncom- 
mon, and of course there is paralysis, chiefly in the form of 
hemiplegia. Paraplegia, general paralysis, softening of 
the brain and chorea, are quite uncommon. Epilepsy is 
met with, and a few cases of idiocy and imbecility have 
been seen. There are no lunatic asylums, and the presence 
of much insanity is highly improbable, considering the high 
estimate entertained of foreign medicine, which would draw 
to our hospitals such cases if they existed, and from a review 
of their whole condition, we should certainly not expect to 
find it prevalent. — Cancrum oris or stomatitis is common, 
of course in young, unhealthy, anaemic, pot-bellied, scrofu- 
lous-looking children. — Goitre is very frequent in the north 
among both sexes. It is found also on the plains and in 
our large cities, and frequently in the absence of the sup- 
posed ordinary producing causes. They have for centuries 
been aware of the power exercised by seaweed ever tumours 
of this and other classes. — Abscesses, ulcers, simple tumours, 
necrosis of bones, especially of the left lower jaw, are 
exceedingly common, in fact constitute a large proportion 
of our practice. — Diseases of the eye are, of course, very com- 
mon, the chief being conjunctivitis, leucoma, entropium, ptery- 
gium, corneal ulcers, and trichiasis. — Throat affections are 
common — their universal plan of counter irritation outside, 
by pinching the skin of the throat, is curious. — Hernia is 
more common in China among men than probably in any 
other country. The native faculty and people are ignor- 
ant of its condition or cause, and suppose it to be a 
collection of air, and so frequently puncture it. — Fistula 
in ano and haemorrhoids, the former called the drip- 
ping or leaking ulcer, are terribly common. — Constipa- 
tion is very common. — In summer, diarrhoea and dysen- 
tery are very frequent, caused chiefly by eating the early 
unripe fruits and vegetables, and in too great a quantity, 
and probably also by exposure at night and sudden and 
severe vicissitudes of temperature. There is much less 
prostration under attacks of dysentery amongst the natives 



55 

than among Europeans. Chinese diarrhoea and dysentery, 
if not among opium smokers, are generally very mild and 
very amenable to simple treatment, and, as already stated, 
congestion and inflammation of the liver, so fatal to 
foreigners, are very rarely, if ever, met with among 
them. Liver diseases are generally considered to be the 
effect of climate, but China rather disproves this. I think 
they are more likely owing to errors of diet. Some of our 
brethren have drawn attention to a close connection between 
typhoid and certain forms of malarious fevers. A question 
which does not yet seem settled is, can typhoid originate 
de novo from the decomposition of fecal accumulations and 
the like ; or, in other words, is it of spontaneous develop- 
ment? There is some evidence collected in China which' 
seems to point to the latter. — Harelip is not very common, 
and where it does exist, there is no desire to have it reme- 
died. They think it cannot be cured, and are generally 
afraid to meddle with what is natural, and has been received 
from one's parents. They are wonderfully free, as a people, 
from deformities, monstrosities, and such like. The Chinese 
never intermarry with one of their own name, and this may 
account for the absence of any diseases supposed to be 
-depending upon or derivable from consanguinity. And 
what is the salvation of any country is early marriage, which 
is universal in China, from the desire to have sons to hand 
down their names and worship at their tombs. The children 
are suckled at the breast for about three years. It is aston- 
ishing what a greatly increased amount of the milk secre- 
tion is obtained in China, even by European mothers, by the 
consumption of a regular daily quantity of well-made rice 
or millet gruel. The introduction of rice was opposed in 
Ireland, because of its supposed property of preventing 
fertility. China is opposed to the potato on the same 
grounds. Infant mortality here is said to be very high, 
and improper food to be the cause par excellence. The 
Chinese substitute for breast milk is a pap made of rice, 
flour and sugar, with which the child's gums are smeared. 
There is no registration in China, and there are no means of 



arriving at an estimate of the mortality of either infants or 
adults in Chinese cities, except by numbering them as they 
pass out of the city gates. In every house there is supposed 
to be a list of the inmates hung up, subject to the inspec- 
tion of the police. Whatever the rate of infant mortality 
may be, we do not think it is so high as in Europe. Many of 
the same causes affecting the adult must also have their 
favourable effect on their offspring. One thing is certain, 
infanticide does not prevail to the extent so generally be- 
lieved among us ; and in the North, whence Europe derived 
her ideas chiefly from the Jesuits of last century, it does 
not exist at all. Disinfection, separation or isolation in cases 
of disease, are but little practised. When had recourse to, 
fire is the usual instrument. Poverty too often prevents 
this expensive process from being carried out, and the worst 
results are to be feared from the purchase of second-hand 
clothes. Infection is, no doubt, thus frequently propagated, 
through the pawn-shops especially, which everywhere 
exist, and are extensively patronised by the poorer classes; 
and are the hot-beds of infection. On the accession of cold 
weather, when the winter garments are withdrawn from 
these establishments, we invariably have an outburst of 
small-pox which lasts over the winter, proving very fatal — 
sadly pitting or blinding those who recover. It might prove 
interesting to classify and tabulate the diseases of China 
according to the order of frequency, as seen at the ports, in 
the Mission hospitals for the Chinese, and among Europeans, 
as seen in private practice. The hospital and customs' half- 
yearly reports would furnish the data, but space forbids. 
The following very brief statement may suffice : — 

At Peking, in the extreme north, in 1865 and 1866, for 
example, out of 3157 and ^066 patients respectively, the 
leading affections were— asthma and chronic bronchitis, 252 
and 885 ; dyspepsia, 349 and 634 ; rheumatism, 140 and 209 ; 
ulcers, 144 and 378 ; scabies, 152 and 1074; conjunctivitis, 
236 and 342 ; diarrhoea, 45 and 54 ; dysentery, 20 and 138'; 
neuralgia, 51 and 224 ; phthisis and tabes mesenterica, 
36 and 171-; struma, 50 and 132 : affections of the ear, 



98 and 122 ; abscesses, 95 and 190; ague, 4 and 31 respec- 
tively. 

At Chef oo, in the north, on the sea, probably our best sani- 
tarium in China, the order runs — dyspepsia, eye disease, skin 
disease, and winter cough. 

At Hankow, in the centre, Dr Reid reports in one year, 
out of 5213 patients — chronic rheumatism, 288 ; ague, 118 ; 
phthisis, 118 ; bronchitis, 250 ; dyspepsia, 246 ; diarrhoea, 80 ; 
conjunctivitis, 132 ; eczema, 113 ; ulcers, 138 ; scabies, 334. 
In another report, he states the order to be, and all of the 
most chronic kind — rheumatism, dyspepsia, malaria disord- 
ers, bronchitis, phthisis, conjunctivitis, ulcers, dysentery and 
scabies. 

Dr Porter Smith, of the same place, in 1864-65, out of 
18,764 patients, catarrh and bronchitis were represented by" 
2876 cases; rheumatism, 2506; skin diseases, 2624; ulcers, 
2100 ; eye diseases, 3769, of which 1433 were for conjunctivitis 
alone. 

At Foochow, in the south, in the summer of 1871, out of a 
foreign population of 1774 there were seen 309 cases, and the 
order was the following — dyspepsia, 64; diarrhoea, 43; 
gonorrhoea, 28 ; ague, 22 ; dysentery, 17 ; primary syphilis, 
16. 

At Swatoiv, further south, the figures stood— ague, 101 ; 
ulcers, 89 ; secondary syphilis, 87 ; dyspepsia, 80 ; ophthal- 
mia and chronic bronchitis, each 64 ; rheumatism, 57 ; anss- 
mia, 44. 

At Canton, in the extreme south, the leading affections 
were — ague, 46 ; diarrhoea, 39 ; rheumatism, 13 ; boils, 14. 

In Formosa, also in the south, the cases stood for the 
summer six months of 1872 — 197 cases of quotidian ague ; 
94 of tertian ; 49 of quartan ; 118 of remittent fever ; 82 of 
chronic rheumatism ; 148 of enlarged spleen ; 68 of dyspep- 
sia ; 67 of chronic ulcers ; 96 of chronic conjunctivitis ; of 
diarrhoea, 25 ; ansemia, 44 ; chronic bronchitis, 39 ; phthisis, 
38 ; worms, 30. 

This must suffice to give a general idea of the prevail- 
ing diseases in the three regions of China, and, with the 



58 

exception of Hankow and Peking, all bordering on the 
coast. 

Remittent and intermittent fevers, as our remarks may 
have already indicated, are extremely common in the south, 
'and form by far the largest proportion of the diseases pecu- 
liar to these regions. Among our forces in China, in 1842, 
periodic fever with chronic fluxes, partly dysenteric and partly 
diarrhoeaic, were the great endemic affections which attacked 
them. These fluxes often succeeded attacks of fever, were 
frequently reciprocal with, and appeared to be vicarious of, 
them. Rice is largely cultivated in the warm, moist south, 
and it is to this marshy, swampy land, we owe the presence 
of so much fever. Dr Wilson has thrown out the supposition 
in the form of a query, that the exhalations from paddy fields 
under regular management, and yielding healthy products of 
vegetable growth, may give rise to intermittent, while the 
stronger poison exhaled from marsh land, through processes 
of rapid and multiplied destruction of vegetable matter, may 
occasion the more concentrated and fatal remittent fever. He 
thinks if the surface could be deprived of its malarious ema- 
nations, and the diseases now inoperative were to remain so, 
Hong-Kong (and this would hold true of China generally) 
would be one of the most salubrious spots in the world. Much 
has been done in this direction since these remarks were 
written, when Hong-Kong became a colony of ours. The 
above writer dwells somewhat largely on this subject, and 
from its own interest and its close connection with the scope 
of this paper, I make no apology for giving a summary of the 
views enunciated. In his Medical Notes on China he states 
that that country ought to be one of the most salubrious, as 
it is naturally one of the most favoured, portions of the earth's 
surface. What is detrimental is believed to be chiefly the 
wilful work of man's hands, or of his neglect and perverse 
ignorance. Certainly some diseases, such as ague, fluxes, 
ulcers and skin affections, might be reduced in frequency and 
force if the people abandoned some of their agricultural and 
economic usages. He mentions the substitution of wheat for 
rice cultivation as the first simple and most powerful instru- 



59 

ment. Wherever land can be got to bear rice it is eagerly 
employed for that purpose. This would do away -with marsh 
land, and by virtue of the absorbent nature of the soil, for our 
expensive and laborious drainage he sees scarcely any call in 
China. As they have long ago adopted one American articfe 
(tobacco), and universally use it, he advises the use of the 
potato, a native of the same country, which at present is ex- 
cluded from Chinese diet. Next in order of importance are 
the measures required to correct the more limited morbific 
influence created and diligently fostered by man, and not the 
product of the soil and climate. He would recommend entire 
change of plan of the towns and structure of the houses; 
would widen streets, make sewers and gutters, and render 
compulsory the speedy removal of dirty and rapidly-decom- 
posing matters from narrow, crowded lanes. He adds that it 
may well excite surprise that such positions do not prove much 
more unhealthy than they are, and become every year abso- 
lutely pestilential. And this becomes more surprising when 
viewed in connection with the domestic and personal habits 
of the people, and here entire change is required to secure great 
increase of health and enjoyment. The one word " cleanliness " 
expresses the want. Itch, which is so universal, and cutaneous 
diseases generally would thus be got rid of. The want of this 
virtue must be otherwise injurious to health. If we bear in 
mind the utter absence of all sanitary science, which we have 
attempted briefly to pourtray, the narrow streets, pent-up 
houses, dense population, want of ventilation, earthen floors, 
absence of cellars, sewers and other channels for under-ground 
purification, stagnant pools and pits of putrefaction in all 
directions, with a high atmospheric heat for half the year, it 
is astonishing that the country is not swept incessantly by 
• fearful epidemics, and ere long depopulated. And we should 
expect the people to be still more unhealthy, and the ravages 
of disease very much greater, if we consider their food, mala- 
ria, extensive use of opium and tobacco, and some would add 
weak tea, their want of personal cleanliness, no body linen, 
almost no washable clothes, and the use of the same garments 
day and night, and when unfit for outside wear, receiving 



60 

another layer, each layer gradually moving inwards a stage 
until thrown off, etc. 

Now, if all this be true — and no one who knows China will 
fail to admit the truth of the description — we may well ask, is 
their general freedom from disease, and especially acute disease, 
and the general health, vitality and activity they exhibit not alto- 
gether very remarkable ? If western sanitary science could re- 
lieve them almost entirely of the affections already indicated as 
prevailing, without planting the diseases of modern European 
life, we should have a country the most populous, the purest 
from disease in the world ; and at the same time it is but 
reasonable to expect that many of their uncontrollable epidemic 
or endemic diseases would be greatly lessened and moderated. 
Small-pox would disappear before vaccination, and the world 
might then have some hope of stamping out this loathsome 
disease. 

Dr Wilson explains the absence of many diseases which are 
elsewhere frequent and occasion much mortality, but which 
in China are comparatively uncommon and unimportant, by 
saying that perhaps the endemic diseases, periodic fever, flux 
and small-pox, being the chief destructive agents, absorb and 
occupy the place of other morbific powers, and that their in- 
fluence is such as not to tolerate the rival action, or even to 
any extent the inferior operation of the more ordinary causes 
of disease. Like Aaron's rod among the wands of the magi- 
cians, they swallow up antagonists which, though feeble in 
their presence, are formidable elsewhere. 

Concluding Remarks. — I have thus attempted, as briefly as 
possible, to give a notion of the causes and conditions of dis- 
eases in China, and the extent to which they prevail. I think 
it is impossible to overrate the influence of climate, food, cus- 
toms and habits on health as well as on disease. The pecu- 
liarities of the Chinese in these respects have been acting in 
unbroken order through long series of years. The endemic 
diseases, as suggested above, may too, to some extent, have 
had their influence in checking or neutralising the morbific 
germs of other diseases, or at least givingthe people a certain 
amount of protection. We know the natives are less susceptible 



61 

to malarious and other malign influences than Europeans, but 
this cause does not, I think, explain all the phenomena. There 
are many useful lessons to be learned from a study of Chinese 
character and habits as affecting health. The one word 
sobriety might sum up the most obvious of the causes of the 
favourable conditions as to health and duration of life which 
obtain in China. - Napoleon said intemperance was incom- 
patible with greatness. A review of the conditions of disease 
in China leads us to believe that insobriety, in its widest accep- 
tation, is incompatible with health and freedom from disease. 
Sobriety is defined by one to be — that we should neither eat 
nor drink more than is necessary for our constitution, in order 
to perform the functions of the mind with ease. The true 
rule of diet to every man, according to another writer, is his 
natural undepraved appetite. Excess is an enemy to nature 
— moderation in every affection and enjoyment is the way to 
preserve health. The Chinese partake sparingly of flesh, in 
many cases from sheer poverty, in other cases from religious 
motives, and in others again to prevent " fires " (inflamma- 
tions), as they express it, from originating in the system and 
setting up diseased action. Buddhism, with its doctrine of 
the transmigration of souls, has rendered an important aid to 
health by inducing among its priests total abstinence from 
animal food, and general temperance in this respect among 
the people as a whole. In certain diseases in our own country 
' our physicians prescribe low diet and absence of animal food, 
and with reason and advantage. A trial of a similar regime 
in health might be equally profitable for both soul and body. 
If temperance — that is, sufficient for wants but not for luxu- 
ries — in eating and drinking were more strictly observed, 
we might hear less frequently of high fevers, acute diseases 
and general inflammations. It is here, perhaps, where 
Europe might with great advantage assimilate herself more 
to Asia, and by so doing acquire much that would prove 
useful in enabling her people to resist morbific influences. 
And as Cornaro expresses it, there would then be the absence 
of all those "distempered humours which bring on defluxions." 
He enjoins a sober regular life as the only happy one in its 



62 

consequences ; and he exhorts and beseeches, all men of sense 
and resolution to possess themselves of this source of health, 
more valuable than all the riches of the universe. We never 
realise what a state might be if its citizens were temperate 
in all things. Taking just enough to live upon is the rigid 
natural law. By obeying this law as nearly as possible we 
should be comparatively free from the external cause of the 
induced diseases, and better, or at least well, protected against 
the consequences of those diseases springing from uncontrol- 
lable causes. As already stated, although the most sober of 
peoples, the Chinese drink no inconsiderable quantity of spirits, 
but excess is almost unknown. They form no exception, there- 
fore, to the rule that all nations have practically repudiated 
the doctrine of water being the simple salutary beverage de- 
signed by nature. From a pretty large and extended ex- 
perience in China, I can, however, confidently assert that the 
aqueous regime has guaranteed the best health and longest 
term of residence there among Europeans, and the more 
slowly we deviate, if at all; from this course the better. Tea 
will be found the most wholesome beverage, promoting health 
and happiness by doing away with noxious and intoxicating 
potions. So far its introduction has been accompanied with 
the most salutary consequences, and it is believed that its ex- 
tensive consumption will most effectually counteract drunken- 
ness and promote health. The author of the Ride to Khiva 
correctly puts it when he says, " This beverage (tea) becomes 
an absolute necessity when riding across the Steppes in mid- 
winter, and is far superior in heat-giving properties to any 
wines and spirits. In fact, a traveller would succumb to the 
cold in the latter, when the former will save his life." Tea has 
been the national beverage of a third of the population of the 
globe for the last 1500 years. The use of boiling and boiled 
water, either alone or with a little tea in it, is characteristic of 
the people, and has been productive of much good and of the 
prevention of much disease. The astringency of the tea, like 
the use of betel nut in India, has been a corrective against 
dysentery and diarrhoea, and the boiling of the water has 
obviated typhoid fever, diarrhoea, calculus, and other diseases. 



63 

We cannot lay too much stress on regularity in everything 
— hours of sleeping, eating, working and exercise. With 
the Chinese there is the perfect appropriation of the sunlight 
in preference to artificial illumination. They rest, work and 
sleep in periods that precisely accord with the periodicity of 
nature. They retire early to rest, opium smokers excepted. 
The streets of Chinese towns are deserted shortly after sunset. 
They rise early ; the Emperor and his court at or shortly after 
midnight. The business of the empire for the day is all 
transacted long before we should think of getting up. Some 
of their fairs are held before, or just at, sunrise. The value 
of regular hours and of rest is little thought of here, and too 
little inculcated. The almost invariable answer given by 
aged persons as to the cause of their longevity is early hours 
and regular habits ; and some one, merely looking at the sub- 
ject in its commercial aspect, has made a calculation of the 
saving in gas and candles which such a course would bring 
about, and it is simply astounding. The Chinese are 
always struck with our activity in everything — we cannot 
even walk slowly ; and although we have enough of time and 
money, it may be, we must still be going a-head, rushing and 
bustling, little thinking that " nourishing our heart," as they 
call it, is any concern of ours. Above all things, the Chinese 
enjoin peace of mind and quietness of body — avoidance of 
anger, fear, grief, anxiety and the violent exercise of the 
passions generally, to which are ascribed more than half their 
disease. The Westerns seem a riddle to them— they fail to 
understand us. We have carried industry and competition to 
an extreme. Our social exigencies override our philosophies. 
Competition in business, speculation, religious controversies^ 
party politics, etc., undermine our health and increase our 
mortality returns. The Chinese do everything quietly and 
methodically, without the slightest exertion^or fuss. They 
seldom do anything for themselves which can be done by 
another. They have few ups and downs in their world. 
Fate regulates everything, and so they are content with their 
lot. If they have wealth they use it ; if none, they do with- 
out it. They live on in one unbroken routine. Worry is 



G4 

unknown. General indolence and ease, disinclination to be 
troubled about matters, a desire to let things take their 
course, trusting that all will come right, are their characteris- 
tics. This state of feeling, partly inculcated by their various 
religious systems and occasioned partly by the climate, and 
in accordance with then unstimulating food and abstemious * 
habits, conduce most effectively to the permanence of their 
institutions and indispose them for any change in their cus- 
toms. I must forbear enlarging further on this subject, as 
this paper has already exceeded the limits assigned to it. We 
trust some of the views advanced may have the effect of 
directing the profession to a consideration of our habits of life 
and civilization generally as bearing upon the question of 
health, and the causation, conditions and prevalence of dis- 
ease. 



BVNN AND WEIGHT, PBINTEH8, OLiSOOW 



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